Provider Demographics
NPI:1346651908
Name:NIX, JONATHAN RILEY (DPT)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:RILEY
Last Name:NIX
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3016 CHADWICKE DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-7861
Mailing Address - Country:US
Mailing Address - Phone:817-999-5741
Mailing Address - Fax:
Practice Address - Street 1:1500 W I 240 SERVICE RD STE A14
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-8203
Practice Address - Country:US
Practice Address - Phone:405-632-1002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-16
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1242457225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist