Individual
TY ALAN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
1801 CHUKKA HINA, DURANT, OK 74701-7117
(580) 920-2100
Mailing address
5450 ROADRUNNER DR, DURANT, OK 74701-2451
(580) 775-3227
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
3010
OK
Other
Enumeration date
10/15/2021
Last updated
10/15/2021
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