Individual
JACOB LIVELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
526 SW 4TH ST STE 200, MOORE, OK 73160-5409
(405) 759-2700
(405) 759-2722
Mailing address
526 SW 4TH ST STE 200, MOORE, OK 73160-5409
(405) 759-2700
(405) 759-2722
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Enumeration date
01/28/2021
Last updated
01/28/2021
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