Individual
ETHAN MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
1 E CLARK BASS BLVD, MCALESTER, OK 74501-4209
(918) 426-1800
Mailing address
1 E CLARK BASS BLVD, MCALESTER, OK 74501-4209
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
3251
OK
Other
Enumeration date
12/14/2021
Last updated
12/14/2021
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