Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 4019 | OK |
NPI | 1336532639 |
---|---|
Provider Name | Kendra Stanaland |
First Address | Tulsa, OK 74137-1603 |
Second Address | Sapulpa, OK 74066-6141 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/03/2015 |
Last Update Date | 11/03/2015 |