Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 112 | OK |
NPI | 1003203787 |
---|---|
Provider Name | Mary Garland |
First Address | Tulsa, OK 74112-4604 |
Second Address | Tulsa, OK 74119-3423 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2015 |
Last Update Date | 21/04/2015 |