Healthcare Provider Details

I. General information

NPI: 1831132620
Provider Name (Legal Business Name): JAMI LEE MOONEY RPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JAMI LEE REDDEN RPT

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 08/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 E CENTRAL BLVD
ANADARKO OK
73005-4405
US

IV. Provider business mailing address

1002 E CENTRAL BLVD
ANADARKO OK
73005-4405
US

V. Phone/Fax

Practice location:
  • Phone: 405-247-2551
  • Fax: 405-247-8248
Mailing address:
  • Phone: 405-247-2551
  • Fax: 405-247-8248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2680
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: