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NPI Code Detail

MEDICARE: JENNIE LEIRD PTA

MEDICARE: JENNIE LEIRD PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant1414OK

General Provider Information

NPI Number : 1225136724
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIE LEIRD PTA
Provider Business Mailing Address
First Line : 1001 NW 9TH ST
Second Line :
City : MOORE
State : OK
Zip : 73160-1811
Country : US
Telephone Number : 405-317-3317
Fax Number :
Provider Business Practice Location Address
First Line : 6500 N PORTLAND AVE
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73116-2035
Country : US
Telephone Number : 405-879-9947
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2006
Last Update Date : 07/08/2007

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