Tyler Wilbourn, PTA
Physical Therapy Assistant in Tecumseh, OK. Individual provider (NPI-1).
NPI number1982303111
StatusActive
Last updated in NPPESFeb 27, 2023
Details
- NPI
- 1982303111
- Entity type
- Individual (NPI-1)
- Name
- Tyler Wilbourn
- Credential
- PTA
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Feb 27, 2023
- Certification date
- Feb 27, 2023
- Last updated
- Feb 27, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 225200000X | Physical Therapy Assistant | 3603 | OK | Yes |
Practice location
503 N Broadway StTecumseh, OK 74873-2017
Phone 405-598-2899
Mailing address
Po Box 3675Shawnee, OK 74802-3675
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