Individual
JASON P HARTOG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPT
Contact information
Practice address
1486 S ELLIOTT ST, PRYOR, OK 74361-8002
(918) 825-2333
(918) 825-6266
Mailing address
4004 S YALE AVE, TULSA, OK 74135-6017
(918) 622-4278
(918) 270-2398
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4015
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7783909
AETNA
—
Enumeration date
08/09/2007
Last updated
04/20/2008
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