Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2938 | OK |
NPI | 1003572876 |
---|---|
Provider Name | Bailey Clark |
First Address | Tulsa, OK 74137-4265 |
Second Address | Tulsa, OK 74137-4265 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2021 |
Last Update Date | 16/11/2021 |