Provider Demographics
NPI:1346416393
Name:POLSON, JEFFREY EVANS (PT)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:EVANS
Last Name:POLSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6585 S YALE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-8315
Mailing Address - Country:US
Mailing Address - Phone:918-481-2767
Mailing Address - Fax:918-481-7611
Practice Address - Street 1:6585 S YALE AVE STE 310
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-8334
Practice Address - Country:US
Practice Address - Phone:918-502-4700
Practice Address - Fax:918-502-4701
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3654225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200135920AMedicaid