Provider Demographics
NPI:1538177142
Name:JONES, JAMES RANDALL (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:RANDALL
Last Name:JONES
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 86
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:OK
Mailing Address - Zip Code:73601-0086
Mailing Address - Country:US
Mailing Address - Phone:580-323-8778
Mailing Address - Fax:580-323-8743
Practice Address - Street 1:509 S. 30TH STREET
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601-0086
Practice Address - Country:US
Practice Address - Phone:580-323-8778
Practice Address - Fax:580-323-8743
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2536225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100664370BMedicaid
OK73159OtherKEMPTON CO./ FIRST HEALTH
OK100604370AMedicaid
OK245803201OtherMEDICARE CROSSOVER CLAIMS
OK245803201OtherMEDICARE MSP