Individual
JERRAD HADA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
520 FLYNN ST, ALVA, OK 73717-2240
(580) 327-3331
(580) 327-3314
Mailing address
520 FLYNN ST, ALVA, OK 73717-2240
(580) 327-3331
(580) 327-3314
Taxonomy
Speciality
Code
Description
License number
State
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
5162
OK
225100000X
Physical Therapist
Primary
PT5162
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200693970A
—
OK
Enumeration date
06/13/2016
Last updated
07/16/2019
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