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1891142295
ETHAN CANTRELL
SAPULPA, OK
NPI
1891142295
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
225200000X Physical Therapy Assistant
(Licence: OK 2645)
Enumeration Date
2016-05-16
Last Update Date
2016-05-16
Business Address
-- ETHAN CANTRELL
1120 RIDGE OAK RD
SAPULPA, OK 74066-8446
Phone number: 918-606-6042
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Mailing Address
-- ETHAN CANTRELL
1120 RIDGE OAK RD
SAPULPA, OK 74066-8446
Phone number:
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