Individual
CODY GARRETT LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
433 E STATE HIGHWAY 152, MUSTANG, OK 73064-4519
(405) 353-2159
Mailing address
440 MERCHANT DR, NORMAN, OK 73069-6470
(405) 809-8713
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5896
PT LICENSE
OK
Enumeration date
10/08/2020
Last updated
11/17/2020
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