Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 1396 | OK |
NPI | 1003038126 |
---|---|
Provider Name | Mrs. Trina M Vannatta |
First Address | Collinsville, OK 74021-4115 |
Second Address | Tulsa, OK 74136-1902 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 08/07/2007 |