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General NPI Number Information
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NPI Number | 1790048882
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Entity Type | Organization
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Legal Business Name | GUYMON PHYSICAL THERAPY AND WELLNESS PLLC
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Dates
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Enumeration Date | 06/22/2012
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Last Update Date | 10/22/2018
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Provider Practice Location Address
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Address Line | 211 NW 5TH ST
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City | GUYMON
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State | OK
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Zip | 73942-5801
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Country | US
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Telephone | 580-338-4789
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Fax | 866-999-0184
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Provider Business Mailing Address
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Address Line | 211 NW 5TH ST
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City | GUYMON
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State | OK
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Zip | 73942-5801
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Country | US
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Telephone | 580-338-4789
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Fax | 866-999-0184
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | JACOB LEE TUTTLE
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Credential | PT
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Telephone | 918-223-5075
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 1929
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 3766
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License Number State | OK
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