| NPI | 1952475154 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDALL WALLACE Director 405-879-6766 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: OK PT2855) |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2020-08-22 |