MEDICARE: JACK ARNOLD TULLY DPT

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	6034	OK

General Provider Information

NPI Number	:	1427624303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACK ARNOLD TULLY DPT

Provider Business Mailing Address
First Line	:	800 NW 6TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73106-7241
Country	:	US
Telephone Number	:	405-609-3667
Fax Number	:	405-609-3697

Provider Business Practice Location Address
First Line	:	7005 SE 15TH ST STE 200
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73110-5126
Country	:	US
Telephone Number	:	405-610-2488
Fax Number	:	405-610-2484

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

Provider Enumeration Date	:	06/01/2021
Last Update Date	:	06/01/2021

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Directions to “ JACK ARNOLD TULLY DPT” Practice Location

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