Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 3563 | OK |
N | 2251S0007X | Physical Therapist - Sports | 3563 | OK |
N | 2251X0800X | Physical Therapist - Orthopedic | 3563 | OK |
NPI | 1306260971 |
---|---|
Provider Name | Mrs. Tonya Ridley |
First Address | Bixby, OK 74008-7108 |
Second Address | Tulsa, OK 74146-5822 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2014 |
Last Update Date | 18/02/2014 |