Provider Demographics
NPI:1437986007
Name:DELANEY, CULLEN (PTA)
Entity type:Individual
Prefix:
First Name:CULLEN
Middle Name:
Last Name:DELANEY
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111175 S 4597 RD
Mailing Address - Street 2:
Mailing Address - City:SALLISAW
Mailing Address - State:OK
Mailing Address - Zip Code:74955-5582
Mailing Address - Country:US
Mailing Address - Phone:479-259-7800
Mailing Address - Fax:
Practice Address - Street 1:213 E REDWOOD AVE
Practice Address - Street 2:
Practice Address - City:SALLISAW
Practice Address - State:OK
Practice Address - Zip Code:74955-2811
Practice Address - Country:US
Practice Address - Phone:918-774-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3763225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant