Individual
MATT JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1260 W COVELL RD, EDMOND, OK 73003-3555
(405) 471-5522
(405) 471-5599
Mailing address
440 MERCHANT DR, NORMAN, OK 73069-6470
(405) 809-8710
(405) 573-6768
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5157
OK
Other
Enumeration date
09/14/2016
Last updated
09/14/2016
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