| NPI | 1508272006 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAWN G WALLACE Member 405-620-0145 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: OK 1796) |
| Enumeration Date | 2014-07-03 |
| Last Update Date | 2020-09-21 |