Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT1123 | OK |
NPI | 1003036799 |
---|---|
Provider Name | Pamela Thacker Kantner |
First Address | Tulsa, OK 74137-5946 |
Second Address | Tulsa, OK 74136-1902 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2007 |
Last Update Date | 08/07/2007 |