Provider Demographics
NPI:1467566935
Name:HALBERG, JENNIFER DAWN (PT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DAWN
Last Name:HALBERG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:DAWN
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3545 NW 58TH ST
Mailing Address - Street 2:SUITE 940E
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4726
Mailing Address - Country:US
Mailing Address - Phone:405-605-1130
Mailing Address - Fax:405-605-1402
Practice Address - Street 1:3545 NW 58TH ST
Practice Address - Street 2:SUITE 940E
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4726
Practice Address - Country:US
Practice Address - Phone:405-605-1130
Practice Address - Fax:405-604-1402
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3894225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist