Individual
JACEY LANE THOMSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
1071 W BLUE STARR DR STE 105, CLAREMORE, OK 74017-2869
(918) 283-2992
(918) 283-2952
Mailing address
2488 E 81ST ST STE 290, TULSA, OK 74137-4265
(918) 494-9341
(918) 494-9355
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4367
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200423090A
—
OK
Enumeration date
02/10/2012
Last updated
02/23/2022
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