Individual
DALTON TY WHITEBIRD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1400 E DOWNING ST, TAHLEQUAH, OK 74464-3324
(918) 456-0641
Mailing address
1400 E DOWNING ST, TAHLEQUAH, OK 74464-3324
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
3033
OK
Other
Enumeration date
08/01/2022
Last updated
08/01/2022
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