Individual
JESSE WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
13000 N MAY AVE, OKLAHOMA CITY, OK 73120-0829
(888) 431-7814
Mailing address
2421 NW 156TH ST, EDMOND, OK 73013-5069
(580) 273-6562
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4039
OK
Other
Enumeration date
12/19/2018
Last updated
12/19/2018
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