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General NPI Number Information
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NPI Number | 1841083383
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Entity Type | Individual
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Provider Name | JORDYN BROOKE LONG PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 05/27/2025
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Last Update Date | 05/27/2025
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Provider Practice Location Address
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Address Line | 1801 PARKVIEW DR
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City | EL RENO
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State | OK
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Zip | 73036-2103
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Country | US
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Telephone | 405-295-1475
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Fax |
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Provider Business Mailing Address
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Address Line | 317 COLTON WAY
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City | ADA
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State | OK
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Zip | 74820-4843
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Country | US
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Telephone | 580-235-1612
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Fax |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 6692
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License Number State | OK
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