Basic Information
| Provider Information | |||||||||
| NPI: | 1558776864 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PHYSICAL THERAPY CENTRAL JONES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12950 E BRITTON RD | ||||||||
| Address2: | |||||||||
| City: | JONES | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730497400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4058098650 | ||||||||
| FaxNumber: | 4053995512 | ||||||||
| Practice Location | |||||||||
| Address1: | 440 MERCHANT DR | ||||||||
| Address2: | |||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730696470 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4058098710 | ||||||||
| FaxNumber: | 4055736768 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2014 | ||||||||
| LastUpdateDate: | 06/25/2014 | ||||||||
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| AuthorizedOfficialLastName: | KOWARDY | ||||||||
| AuthorizedOfficialFirstName: | KARLA | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 4058098710 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | PHYSICAL THERAPY CENTRAL INC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 4685 | OK | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.