Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 3063 | OK |
NPI | 1003995515 |
---|---|
Provider Name | Pamela Guenther |
First Address | Jenks, OK 74037-2417 |
Second Address | Tulsa, OK 74133-3267 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2006 |
Last Update Date | 08/07/2007 |