Provider Demographics
NPI:1336385343
Name:WELDON, SARAH ANN (PTA)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ANN
Last Name:WELDON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65724 E 160 RD
Mailing Address - Street 2:
Mailing Address - City:WYANDOTTE
Mailing Address - State:OK
Mailing Address - Zip Code:74370-2337
Mailing Address - Country:US
Mailing Address - Phone:918-678-2445
Mailing Address - Fax:
Practice Address - Street 1:36488 S HIGHWAY 82
Practice Address - Street 2:
Practice Address - City:VINITA
Practice Address - State:OK
Practice Address - Zip Code:74301-7438
Practice Address - Country:US
Practice Address - Phone:918-256-0381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-22
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1738225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant