Healthcare Provider Details

I. General information

NPI: 1831368257
Provider Name (Legal Business Name): JENNY DAWN BUSTER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/29/2008
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 BRIAN STREET
CARNEGIE OK
73015
US

IV. Provider business mailing address

PO BOX 938
CARNEGIE OK
73015
US

V. Phone/Fax

Practice location:
  • Phone: 580-654-1144
  • Fax:
Mailing address:
  • Phone: 580-654-1144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2657
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: