Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 528 | OK |
NPI | 1013304641 |
---|---|
Provider Name | Peggy Hopkins |
First Address | Tulsa, OK 74108-5542 |
Second Address | Tulsa, OK 74108-5542 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2015 |
Last Update Date | 21/04/2015 |