Doctor Name: | MARY JOHNS |
NPI Number: | 1164852265 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | DPT |
License Number: | 4622 |
Business Practice Address: | 6800 Nw 39th Expy Bethany, OK - 730082513 |
Business Phone Number: | 4054409866 |
Business Fax Number: | 4057820024 |
Mailing Address: | 6800 Nw 39th Expy, BETHANY |
State: | OK |
Postal Code: | 730082513 |
Phone Number: | 4054409866 |
Fax Number: | 4057820024 |
NPI Enumeration Date: | 11/26/2013 |
NPI Last Update Date: | 10/19/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2251P0200X |
License Number: | 4622 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | Pediatrics |
Taxonomy Definition: |