Provider Demographics
NPI:1487038337
Name:MUELLER, JESSICA (PT)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:MUELLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:CANALES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6729 NW 39TH EXPY
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:OK
Mailing Address - Zip Code:73008-2605
Mailing Address - Country:US
Mailing Address - Phone:405-440-3126
Mailing Address - Fax:
Practice Address - Street 1:101 S SAINTS BLVD STE 116
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-3082
Practice Address - Country:US
Practice Address - Phone:405-359-1864
Practice Address - Fax:405-359-1865
Is Sole Proprietor?:No
Enumeration Date:2015-07-09
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5028225100000X
TX1258423225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist