Provider Demographics
NPI:1457924383
Name:BLEVINS, HAILEY JORDAN (PT, DPT, ATC)
Entity Type:Individual
Prefix:
First Name:HAILEY
Middle Name:JORDAN
Last Name:BLEVINS
Suffix:
Gender:F
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9601 60TH ST
Mailing Address - Street 2:
Mailing Address - City:NOBLE
Mailing Address - State:OK
Mailing Address - Zip Code:73068-5437
Mailing Address - Country:US
Mailing Address - Phone:405-361-7989
Mailing Address - Fax:
Practice Address - Street 1:724 24TH AVE NW STE 100
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6214
Practice Address - Country:US
Practice Address - Phone:405-447-1571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5980225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist