Provider Demographics
NPI:1417080888
Name:DURANT PHYSICAL THERAPY & AQUATIC CENTER
Entity Type:Organization
Organization Name:DURANT PHYSICAL THERAPY & AQUATIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPY ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:ALLENE
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:580-920-2231
Mailing Address - Street 1:1004 N 19TH AVE BLDG 4
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-3017
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1004 N 19TH AVE BLDG 4
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-3017
Practice Address - Country:US
Practice Address - Phone:580-920-2231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1340225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty