Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 3108 | OK |
NPI | 1003464991 |
---|---|
Provider Name | Garrett Lee Field |
First Address | Tulsa, OK 74104-4307 |
Second Address | Tulsa, OK 74135-1812 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2019 |
Last Update Date | 03/09/2019 |