Healthcare Provider Details

I. General information

NPI: 1730298001
Provider Name (Legal Business Name): JASON WHEAT MPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 12/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1726 S DIVISION ST SUITE A
GUTHRIE OK
73044-6019
US

IV. Provider business mailing address

825 N BROADWAY AVE SUITE 400
OKLAHOMA CITY OK
73102-6039
US

V. Phone/Fax

Practice location:
  • Phone: 405-285-8845
  • Fax: 405-285-8848
Mailing address:
  • Phone: 405-609-3670
  • Fax: 405-605-8638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: