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1073977716
STACEY LONG
TULSA, OK
NPI
1073977716
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Former Name
STACEY LYNN KETCHUM
Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
225100000X Physical Therapist
(Licence: OK 2734)
Enumeration Date
2016-04-08
Last Update Date
2016-04-08
Business Address
-- STACEY LONG PT
4808 S 109TH EAST AVE SUITE 100
TULSA, OK 74146-5822
Phone number: 918-392-1482
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Mailing Address
-- STACEY LONG PT
4808 S 109TH EAST AVE SUITE 100
TULSA, OK 74146-5822
Phone number: 918-392-1482
Copy
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