Individual provider Active NPI

Jeffery S Clemons, PT

  • Physical Therapist
  • Ardmore, OK
National Provider Identifier
1639186943
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2801 Issued in OK
Practice address
2002 12TH Ave NW
Ste a
Ardmore, OK 73401-1227
Phone
(580) 226-9235
Fax
(580) 226-9239
NPI assigned
Aug 1, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 2801 OK Primary

Addresses

Primary practice location

2002 12TH Ave NW
Ste a
Ardmore, OK 73401-1227

Mailing address

2232 W Houston St
Broken Arrow, OK 74012-3529
Phone (918) 259-9522

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050428000315 OK Practitioner - Physical Therapist in Private Practice 1951355759 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Select Physical Therapy Holdings Inc CurrentSince Dec 31, 2020 Accepting new patients
Select Physical Therapy Holdings Inc Physical Therapist Current Accepting new patients
Select Physical Therapy Holdings, Inc. Physical Therapist CurrentSince Dec 31, 2020 Accepting new patients
Excel-Ardmore LLC Physical Therapist CurrentSince Jun 1, 2007 Accepting new patients
Excel Therapy Specialists, LLC Physical Therapist Past Accepting new patients
Excel Therapy Specialists, LLC Physical Therapist Past Accepting new patients

Locations

1202 Merrick Dr
Ardmore, OK 73401
Phone (580) 226-6754

2002 12th Ave NW
Ste A
Ardmore, OK 73401
Phone (580) 226-9235

2232 W Houston St
Broken Arrow, OK 74012
Phone (918) 259-9522

1010 Garth Brooks Blvd
Ste 135
Yukon, OK 73099
Phone (405) 350-2000

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1639186943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2232 W HOUSTON ST",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740123529",
            "telephone_number": "918-259-9522",
            "fax_number": "918-259-9521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2002 12TH AVE NW",
            "address_2": "STE A",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "734011227",
            "telephone_number": "580-226-9235",
            "fax_number": "580-226-9239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLEMONS",
        "first_name": "JEFFERY",
        "middle_name": "S",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OK",
            "license": "2801",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ardmore, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.