Provider Demographics
NPI:1578534996
Name:PIERCEY, JIMMY (PT)
Entity Type:Individual
Prefix:MR
First Name:JIMMY
Middle Name:
Last Name:PIERCEY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11620 MILL HOLLOW CT
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73131-7522
Mailing Address - Country:US
Mailing Address - Phone:405-810-2902
Mailing Address - Fax:405-810-2905
Practice Address - Street 1:6801 N CLASSEN BLVD
Practice Address - Street 2:STE B
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-7205
Practice Address - Country:US
Practice Address - Phone:405-810-2902
Practice Address - Fax:405-810-2905
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT 1949225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK249506703Medicare ID - Type Unspecified