MEDICARE: MR. JIMMY PIERCEY PT

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	PT 1949	OK

General Provider Information

NPI Number	:	1578534996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JIMMY PIERCEY PT

Provider Business Mailing Address
First Line	:	11620 MILL HOLLOW CT
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73131-7522
Country	:	US
Telephone Number	:	405-810-2902
Fax Number	:	405-810-2905

Provider Business Practice Location Address
First Line	:	6801 N CLASSEN BLVD
Second Line	:	STE B
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-7205
Country	:	US
Telephone Number	:	405-810-2902
Fax Number	:	405-810-2905

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

Provider Enumeration Date	:	02/01/2006
Last Update Date	:	10/23/2008

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Directions to “ MR. JIMMY PIERCEY PT” Practice Location

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