Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 2686 | OK |
NPI | 1033390950 |
---|---|
Provider Name | Mr. Wesley David Lawless |
First Address | Tulsa, OK 74133-5716 |
Second Address | Tulsa, OK 74133-5716 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2007 |
Last Update Date | 19/11/2007 |