Provider Demographics
NPI:1013500701
Name:SWEATT, JENNIFER D (PTA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:D
Last Name:SWEATT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 361
Mailing Address - Street 2:
Mailing Address - City:MANNFORD
Mailing Address - State:OK
Mailing Address - Zip Code:74044-0361
Mailing Address - Country:US
Mailing Address - Phone:918-865-7020
Mailing Address - Fax:918-865-7039
Practice Address - Street 1:112 EVANS AVE
Practice Address - Street 2:
Practice Address - City:MANNFORD
Practice Address - State:OK
Practice Address - Zip Code:74044
Practice Address - Country:US
Practice Address - Phone:918-865-7020
Practice Address - Fax:918-865-7039
Is Sole Proprietor?:No
Enumeration Date:2021-02-15
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3075225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK3075OtherOKLAHOLMA MEDICAL BOARD PTA LICENSE