Individual
MISS JENNY DAWN BUSTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
2 BRIAN STREET, CARNEGIE, OK 73015
(580) 654-1144
Mailing address
PO BOX 938, CARNEGIE, OK 73015
(580) 654-1144
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2657
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201269500A
—
OK
01
—
2657
OKLAHOMA BOARD OF MEDICAL LICENSURE
OK
Enumeration date
02/29/2008
Last updated
11/26/2024
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