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1679236871
TY ALAN JACKSON
DURANT, OK
NPI
1679236871
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
225200000X Physical Therapy Assistant
(Licence: OK 3010)
Enumeration Date
2021-10-15
Last Update Date
2021-10-15
Business Address
TY ALAN JACKSON PTA
1801 CHUKKA HINA
DURANT, OK 74701-7117
Phone number: 580-920-2100
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Mailing Address
TY ALAN JACKSON PTA
5450 ROADRUNNER DR
DURANT, OK 74701-2451
Phone number: 580-775-3227
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