Individual
JASON WAYNE EIDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
211 NW 5TH ST, GUYMON, OK 73942-4203
(580) 651-0783
Mailing address
211 NW 5TH ST, GUYMON, OK 73942-4203
(580) 651-0783
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2883
OK
Other
Enumeration date
06/24/2021
Last updated
06/24/2021
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