Provider Demographics
NPI:1356622914
Name:ONG, JONATHAN C (DPT)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:C
Last Name:ONG
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:526 SW 4TH STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160
Mailing Address - Country:US
Mailing Address - Phone:918-864-5848
Mailing Address - Fax:
Practice Address - Street 1:13390 NE 23RD ST
Practice Address - Street 2:
Practice Address - City:CHOCTAW
Practice Address - State:OK
Practice Address - Zip Code:73020-8622
Practice Address - Country:US
Practice Address - Phone:405-769-5555
Practice Address - Fax:405-769-5558
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT38123225100000X
OK4481225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFL236ZMedicare PIN