NPI 1043025836 · live from the CMS NPI Registry
Jordan Benson
Physical Therapist in Shawnee, OK. National Provider Identifier 1043025836, active.
NPI record
| NPI | 1043025836 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Physical Therapist 225100000X |
| Practice location | 781 Grand Casino Blvd, Shawnee, OK 74804 |
| Practice phone | 405-695-6004 |
| Mailing address | 16212 Juliet Dr, Edmond, OK 73013 |
| Enumerated | February 10, 2025 |
| Last updated | February 10, 2025 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Physical Therapist primary | 225100000X | 6667 (OK) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.