Individual
ETHAN CANTRELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1120 RIDGE OAK RD, SAPULPA, OK 74066-8446
(918) 606-6042
Mailing address
1120 RIDGE OAK RD, SAPULPA, OK 74066-8446
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2645
OK
Other
Enumeration date
05/16/2016
Last updated
05/16/2016
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