Individual
JILLYAN AVERY LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
8165 S MINGO RD STE 101, TULSA, OK 74133-4667
(918) 615-6280
(918) 615-6240
Mailing address
8165 S MINGO RD STE 101, TULSA, OK 74133-4667
(918) 615-6280
(918) 615-6240
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
3281
OK
225200000X
Physical Therapy Assistant
Primary
3281
OK
Other
Enumeration date
02/22/2021
Last updated
02/18/2026
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