Individual
NATHAN HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
105 N MAIN ST, KINGFISHER, OK 73750-2730
(405) 375-5654
Mailing address
440 MERCHANT DR, NORMAN, OK 73069-6470
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
3008
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3008
PTA LICENSE
OK
Enumeration date
03/17/2021
Last updated
03/17/2021
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