Provider Demographics
NPI:1720282197
Name:DYE, JAN HODGES (PT)
Entity Type:Individual
Prefix:MRS
First Name:JAN
Middle Name:HODGES
Last Name:DYE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 BRETT CT
Mailing Address - Street 2:
Mailing Address - City:GOLDSBY
Mailing Address - State:OK
Mailing Address - Zip Code:73093
Mailing Address - Country:US
Mailing Address - Phone:405-288-2116
Mailing Address - Fax:
Practice Address - Street 1:171 BRETT CT
Practice Address - Street 2:
Practice Address - City:GOLDSBY
Practice Address - State:OK
Practice Address - Zip Code:73093-1008
Practice Address - Country:US
Practice Address - Phone:405-288-2116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1261225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist