Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2238 | OK |
NPI | 1003240128 |
---|---|
Provider Name | Mr. Cameron David Parker |
First Address | Claremore, OK 74017-3165 |
Second Address | Claremore, OK 74017-3165 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2013 |
Last Update Date | 26/08/2013 |