Individual
AMIRA AL-JIBOORI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPT
Contact information
Practice address
200 N MAIN ST STE C, SAND SPRINGS, OK 74063-7638
(918) 245-0111
(918) 245-3555
Mailing address
4812 E 33RD ST, TULSA, OK 74135-2038
(918) 622-4126
(918) 270-2398
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
3990
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200118440 A
—
OK
01
—
200118440A
MEDICAID LEGACY
OK
01
—
243725406
MEDICARE LEGACY
OK
01
—
700522061
MEDICARE LEGACY/PROVIDER
OK
01
—
731512096001
BCBS LEGACY/PROVIDER
OK
01
—
7803973
AETTNA
OK
Enumeration date
08/05/2007
Last updated
06/20/2012
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