Provider Demographics
NPI:1205720539
Name:OLANOLAN, JAYBERT ISON
Entity type:Individual
Prefix:
First Name:JAYBERT
Middle Name:ISON
Last Name:OLANOLAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 S IKE AVE
Mailing Address - Street 2:
Mailing Address - City:MONAHANS
Mailing Address - State:TX
Mailing Address - Zip Code:79756-4737
Mailing Address - Country:US
Mailing Address - Phone:432-943-6723
Mailing Address - Fax:
Practice Address - Street 1:420 S IKE AVE
Practice Address - Street 2:
Practice Address - City:MONAHANS
Practice Address - State:TX
Practice Address - Zip Code:79756-4737
Practice Address - Country:US
Practice Address - Phone:432-943-6723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1317309225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist