Individual
MEMORY JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
2840 E 101ST ST, TULSA, OK 74137-5601
(918) 392-1400
Mailing address
4802 S 109TH EAST AVE, TULSA, OK 74146-5822
(918) 392-1513
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6737
PT LICENSE
OK
Enumeration date
07/28/2025
Last updated
07/28/2025
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