Provider Demographics
NPI:1033487970
Name:COX, JUANITA JEAN (PTA)
Entity Type:Individual
Prefix:
First Name:JUANITA
Middle Name:JEAN
Last Name:COX
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:JEANNIE
Other - Middle Name:
Other - Last Name:COX
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:901 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OK
Mailing Address - Zip Code:74020-1205
Mailing Address - Country:US
Mailing Address - Phone:918-358-2483
Mailing Address - Fax:
Practice Address - Street 1:901 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OK
Practice Address - Zip Code:74020-1205
Practice Address - Country:US
Practice Address - Phone:918-358-2483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK81225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant