Provider Demographics
NPI:1124239959
Name:CRABB, JOHNATHAN BUHLER (PT)
Entity type:Individual
Prefix:
First Name:JOHNATHAN
Middle Name:BUHLER
Last Name:CRABB
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:PO BOX 1282
Mailing Address - Street 2:
Mailing Address - City:HARRAH
Mailing Address - State:OK
Mailing Address - Zip Code:73045-1282
Mailing Address - Country:US
Mailing Address - Phone:405-406-6527
Mailing Address - Fax:
Practice Address - Street 1:320 N 4TH AVE
Practice Address - Street 2:
Practice Address - City:STROUD
Practice Address - State:OK
Practice Address - Zip Code:74079-3641
Practice Address - Country:US
Practice Address - Phone:918-968-2655
Practice Address - Fax:918-968-2659
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2342225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist