Individual
JORDAN T PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3401 W GORE BLVD, LAWTON, OK 73505-6332
(580) 355-8620
Mailing address
402 NW SHERIDAN RD APT 1705, LAWTON, OK 73505-6573
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
PTA004927
GA
225200000X
Physical Therapy Assistant
Primary
PTA31577
FL
Other
Enumeration date
02/20/2023
Last updated
02/20/2023
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