Individual
REO REA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2244 E SHAWNEE RD, MUSKOGEE, OK 74403-1443
(918) 684-9999
(888) 663-4223
Mailing address
2244 E SHAWNEE RD, MUSKOGEE, OK 74403-1443
(918) 684-9999
(888) 663-4223
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2669
OK
Other
Enumeration date
01/28/2021
Last updated
01/28/2021
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