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General NPI Number Information
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NPI Number | 1386307791
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Entity Type | Individual
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Provider Name | JOHNATHAN ADAM BROWN PTA
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Gender | Male
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Dates
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Enumeration Date | 10/21/2021
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Last Update Date | 10/21/2021
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Provider Practice Location Address
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Address Line | ONE CHOCTAW WAY
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City | TALIHINA
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State | OK
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Zip | 74571
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Country | US
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Telephone | 918-567-7000
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Fax | 918-567-7119
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Provider Business Mailing Address
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Address Line | 1 CHOCTAW WAY
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City | TALIHINA
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State | OK
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Zip | 74571-2022
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Country | US
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Telephone | 918-567-7000
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Fax | 918-567-7119
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 1197
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License Number State | OK
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