Healthcare Provider Details

I. General information

NPI: 1417486366
Provider Name (Legal Business Name): JESSICA DAVIS DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2017
Last Update Date: 06/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4008 S YALE AVE
TULSA OK
74135-6017
US

IV. Provider business mailing address

4812 E 33RD ST
TULSA OK
74135-2038
US

V. Phone/Fax

Practice location:
  • Phone: 918-622-4278
  • Fax: 918-622-4844
Mailing address:
  • Phone: 918-622-4126
  • Fax: 918-270-2398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5287
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: