Provider Demographics
NPI:1831406826
Name:STORTS, JARED L (MPT)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:L
Last Name:STORTS
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 MORNINGSIDE DR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-4955
Mailing Address - Country:US
Mailing Address - Phone:580-490-1936
Mailing Address - Fax:
Practice Address - Street 1:11623 ARBOR ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-2981
Practice Address - Country:US
Practice Address - Phone:402-334-6068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-12
Last Update Date:2010-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4324225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist