Provider Demographics
NPI:1972685469
Name:STANTON, JIMMY ROYCE JR (PT)
Entity type:Individual
Prefix:
First Name:JIMMY
Middle Name:ROYCE
Last Name:STANTON
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:JR
Other - Middle Name:
Other - Last Name:STANTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:700 NW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-1212
Mailing Address - Country:US
Mailing Address - Phone:405-609-3658
Mailing Address - Fax:800-506-3795
Practice Address - Street 1:4645 W GORE BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-6041
Practice Address - Country:US
Practice Address - Phone:580-355-6785
Practice Address - Fax:580-355-6788
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
OK1686225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist