Provider Demographics
NPI:1346413390
Name:DIPPREY, JASON M (MPT)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:M
Last Name:DIPPREY
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1354 NW HOMESTEAD DR
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-5223
Mailing Address - Country:US
Mailing Address - Phone:580-699-5455
Mailing Address - Fax:580-215-4991
Practice Address - Street 1:1354 NW HOMESTEAD DR
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-5223
Practice Address - Country:US
Practice Address - Phone:580-699-5455
Practice Address - Fax:580-215-4991
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4007225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist