Provider Demographics
NPI:1780696443
Name:CHAMBERS, JEFF WALTER (PT)
Entity type:Individual
Prefix:MR
First Name:JEFF
Middle Name:WALTER
Last Name:CHAMBERS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N MAIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:SAND SPRINGS
Mailing Address - State:OK
Mailing Address - Zip Code:74063-7638
Mailing Address - Country:US
Mailing Address - Phone:918-245-0111
Mailing Address - Fax:918-245-3555
Practice Address - Street 1:4812 E 33RD ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2038
Practice Address - Country:US
Practice Address - Phone:918-622-4126
Practice Address - Fax:918-270-2398
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1710225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200080820AMedicaid
OK244612816OtherMEDICARE LEGACY
OKP00317711OtherMEDICARE RAILRAOD
OK200080820AOtherMEDICAID LEGACY
OK244612816Medicare PIN