MEDICARE: JASON M DIPPREY MPT

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
1	225100000X	Physical Therapist	4007	OK

General Provider Information

NPI Number	:	1346413390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON M DIPPREY MPT

Provider Business Mailing Address
First Line	:	1354 NW HOMESTEAD DR
Second Line	:
City	:	LAWTON
State	:	OK
Zip	:	73505-5223
Country	:	US
Telephone Number	:	580-699-5455
Fax Number	:	580-215-4991

Provider Business Practice Location Address
First Line	:	1354 NW HOMESTEAD DR
Second Line	:
City	:	LAWTON
State	:	OK
Zip	:	73505-5223
Country	:	US
Telephone Number	:	580-699-5455
Fax Number	:	580-215-4991

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2008
Last Update Date	:	06/03/2016

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