Individual
JEREMY BEAU RAPP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPT
Contact information
Practice address
122 E GLAYDAS, HOOKER, OK 73945
(580) 652-1111
(580) 652-1112
Mailing address
122 E GLAYDAS AVE, HOOKER, OK 73945
(580) 652-1111
(580) 652-1112
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200118240A
—
OK
01
—
OK400025
MEDICARE PTAN
OK
Enumeration date
07/26/2007
Last updated
02/12/2021
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