Provider Demographics
NPI:1689836041
Name:BARRETT, JEFF AUSTIN (PTA)
Entity Type:Individual
Prefix:MR
First Name:JEFF
Middle Name:AUSTIN
Last Name:BARRETT
Suffix:
Gender:M
Credentials:PTA
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Other - Credentials:
Mailing Address - Street 1:4100 S DOUGLAS AVE
Mailing Address - Street 2:4100 SOUTH DOUGLAS AVENUE
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73109-3210
Mailing Address - Country:US
Mailing Address - Phone:405-644-5445
Mailing Address - Fax:405-636-7178
Practice Address - Street 1:4100 S DOUGLAS AVE
Practice Address - Street 2:4100 SOUTH DOUGLAS AVENUE
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-3210
Practice Address - Country:US
Practice Address - Phone:405-644-5445
Practice Address - Fax:405-636-7178
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK1570225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant