Healthcare Provider Details

I. General information

NPI: 1669043691
Provider Name (Legal Business Name): JESSICA L. GUTHERY PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2021
Last Update Date: 05/18/2023
Certification Date: 05/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 W BOYD ST
NORMAN OK
73069-4801
US

IV. Provider business mailing address

1201 W BOYD ST
NORMAN OK
73069-4801
US

V. Phone/Fax

Practice location:
  • Phone: 405-366-7898
  • Fax: 405-366-0010
Mailing address:
  • Phone: 405-366-7898
  • Fax: 405-366-0010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number3370
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: