Individual
JESS LYNDON SOTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, PT
Contact information
Practice address
1900 N 14TH ST, PONCA CITY, OK 74601-2035
(580) 765-0518
Mailing address
2700 MEADOW LN, PONCA CITY, OK 74604-2018
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT1742
OK
Other
Enumeration date
04/02/2007
Last updated
07/08/2007
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