Healthcare Provider Details

I. General information

NPI: 1437083813
Provider Name (Legal Business Name): JONATHAN FARMER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 N AIR DEPOT BLVD STE X
MIDWEST CITY OK
73110-1760
US

IV. Provider business mailing address

3008 BROOKE RD
CHICKASHA OK
73018-7799
US

V. Phone/Fax

Practice location:
  • Phone: 405-732-1766
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number4040
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: