Healthcare Provider Details

I. General information

NPI: 1558776864
Provider Name (Legal Business Name): PHYSICAL THERAPY CENTRAL JONES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2014
Last Update Date: 06/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 MERCHANT DR
NORMAN OK
73069-6470
US

IV. Provider business mailing address

12950 E BRITTON RD
JONES OK
73049-7400
US

V. Phone/Fax

Practice location:
  • Phone: 405-809-8710
  • Fax: 405-573-6768
Mailing address:
  • Phone: 405-809-8650
  • Fax: 405-399-5512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4685
License Number StateOK

VIII. Authorized Official

Name: KARLA KOWARDY
Title or Position: ADMINISTRATOR
Credential:
Phone: 405-809-8710