Provider Demographics
NPI:1831132620
Name:MOONEY, JAMI LEE (RPT)
Entity Type:Individual
Prefix:
First Name:JAMI
Middle Name:LEE
Last Name:MOONEY
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:JAMI
Other - Middle Name:LEE
Other - Last Name:REDDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPT
Mailing Address - Street 1:1002 E CENTRAL BLVD
Mailing Address - Street 2:
Mailing Address - City:ANADARKO
Mailing Address - State:OK
Mailing Address - Zip Code:73005-4405
Mailing Address - Country:US
Mailing Address - Phone:405-247-2551
Mailing Address - Fax:405-247-8248
Practice Address - Street 1:1002 E CENTRAL BLVD
Practice Address - Street 2:
Practice Address - City:ANADARKO
Practice Address - State:OK
Practice Address - Zip Code:73005-4405
Practice Address - Country:US
Practice Address - Phone:405-247-2551
Practice Address - Fax:405-247-8248
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2680225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist