Organization
GUYMON PHYSICAL THERAPY AND WELLNESS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACOB LEE TUTTLE PT (OWNER/PHYSICAL THERAPIST)
(918) 223-5075
Entity
Organization
Contact information
Practice address
211 NW 5TH ST, GUYMON, OK 73942-5801
(580) 338-4789
(866) 999-0184
Mailing address
211 NW 5TH ST, GUYMON, OK 73942-5801
(580) 338-4789
(866) 999-0184
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
—
—
261QP2000X
Physical Therapy Clinic/Center
1929
OK
261QP2000X
Physical Therapy Clinic/Center
Primary
3766
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12413288
CAQH
OK
05
—
200459990A
—
OK
Enumeration date
06/22/2012
Last updated
10/22/2018
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