Provider Demographics
NPI:1083804223
Name:WILLEY, JONATHAN B (PTA)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:B
Last Name:WILLEY
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
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Mailing Address - Street 1:8011 S SHERIDAN RD UNIT B
Mailing Address - Street 2:SQUARE ONE SHOPPING CENTER
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-8950
Mailing Address - Country:US
Mailing Address - Phone:918-481-3390
Mailing Address - Fax:918-481-3510
Practice Address - Street 1:6767 S YALE AVE STE B
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-3302
Practice Address - Country:US
Practice Address - Phone:918-494-3000
Practice Address - Fax:918-494-0003
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK1525225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant