Basic Information
| Provider Information | |||||||||
| NPI: | 1457924383 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLEVINS | ||||||||
| FirstName: | HAILEY | ||||||||
| MiddleName: | JORDAN | ||||||||
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| Credential: | PT, DPT, ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9601 60TH ST | ||||||||
| Address2: | |||||||||
| City: | NOBLE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730685437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053617989 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 724 24TH AVE NW STE 100 | ||||||||
| Address2: | |||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730696214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4054471571 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2021 | ||||||||
| LastUpdateDate: | 07/19/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 5980 | OK | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.