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1255941969
TIERRA LASHAWN FULTZ TAKYI-MICAH
OKLAHOMA CITY, OK
NPI
1255941969
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Former Name
TIERRA LASHAWN FULTZ
Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
225100000X Physical Therapist
(Licence: OK 5789)
Enumeration Date
2020-08-06
Last Update Date
2020-08-06
Business Address
TIERRA LASHAWN FULTZ TAKYI-MICAH PT, DPT
309 SW 59TH ST STE 305
OKLAHOMA CITY, OK 73109-8324
Phone number: 405-355-3239
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Mailing Address
TIERRA LASHAWN FULTZ TAKYI-MICAH PT, DPT
5009 AVION CT
OKLAHOMA CITY, OK 73135-5090
Phone number: 918-809-4228
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