Active NPI
Jess Olson
- Physical Therapist
- Ardmore, OK
National Provider Identifier
1629428230
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 4539
- Practice address
- 924 Stanley St SW
Ardmore, OK 73401-4636 - Phone
- (580) 465-8646
- NPI assigned
- Jun 14, 2016
- Last updated
- Jun 14, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 4539 | OK | Primary |
Addresses
Primary practice location
924 Stanley St SW
Ardmore, OK 73401-4636
Mailing address
924 Stanley St SW
Ardmore, OK 73401-4636
Phone (580) 465-8646
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4539 | OK | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1465862400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1465862400000",
"number": "1629428230",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "924 STANLEY ST SW",
"city": "ARDMORE",
"state": "OK",
"postal_code": "734014636",
"telephone_number": "580-465-8646"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "924 STANLEY ST SW",
"city": "ARDMORE",
"state": "OK",
"postal_code": "734014636",
"telephone_number": "580-465-8646"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OLSON",
"first_name": "JESS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-06-14",
"last_updated": "2016-06-14",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "OK",
"license": "4539",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ardmore, OK
- Oklahoma Families First Inc
- Oklahoma Families First, Inc
- Oklahoma Healthcare Opco 2 LLC
- Oklahoma Integrated Care PLC
- Oklahoma Oncology and Hematology, P.C. (Cancer Care Associates)
- Oludayo Olusanya, M.D.
- Oms of Southern Oklahoma PLLC
- Christian Jolene Ornelas
- Ortho Plus LLC
- Billy Joe Oshields, CASE MANAGER
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.