Provider Demographics
NPI:1346874476
Name:HILLIARY, BRIAN JASON (PTA)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:JASON
Last Name:HILLIARY
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2051 NW MCINTOSH RD
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:OK
Mailing Address - Zip Code:73538-2547
Mailing Address - Country:US
Mailing Address - Phone:508-574-8241
Mailing Address - Fax:
Practice Address - Street 1:501 SE FLOWER MOUND RD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-6388
Practice Address - Country:US
Practice Address - Phone:580-351-6511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1409225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant