Individual
MIKAELA WEATHERLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
10512 N 110TH EAST AVE, OWASSO, OK 74055-6636
(918) 376-8550
Mailing address
10512 N 110TH EAST AVE, OWASSO, OK 74055-6636
(918) 376-8550
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
6369
OK
Other
Enumeration date
08/28/2025
Last updated
08/28/2025
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