Provider Demographics
NPI:1730654310
Name:GLASGOW, JORDAN MICHELLE (PTA)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:MICHELLE
Last Name:GLASGOW
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:MICHELLE
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:9210 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-4982
Mailing Address - Country:US
Mailing Address - Phone:405-692-6333
Mailing Address - Fax:405-692-1513
Practice Address - Street 1:9210 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-4982
Practice Address - Country:US
Practice Address - Phone:405-692-6333
Practice Address - Fax:405-692-1513
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2923225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant