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General NPI Number Information
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NPI Number | 1306109277
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Entity Type | Individual
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Provider Name | DAMON MOORMAN BS, PTA
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Gender | Male
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Dates
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Enumeration Date | 06/16/2012
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Last Update Date | 06/16/2012
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Provider Practice Location Address
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Address Line | 6201 E 36TH ST
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City | TULSA
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State | OK
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Zip | 74135-5810
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Country | US
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Telephone | 918-622-3430
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Fax |
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Provider Business Mailing Address
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Address Line | 8250 E 33RD ST
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City | TULSA
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State | OK
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Zip | 74145-1406
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 501
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License Number State | OK
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