MEDICARE: DEBORAH RENEE EASTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2517	OK

General Provider Information

NPI Number	:	1366204059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH RENEE EASTON

Provider Business Mailing Address
First Line	:	628 NW 196TH CT
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73012-1239
Country	:	US
Telephone Number	:	405-921-1326
Fax Number	:

Provider Business Practice Location Address
First Line	:	1310 E OKLAHOMA AVE
Second Line	:
City	:	GUTHRIE
State	:	OK
Zip	:	73044-3757
Country	:	US
Telephone Number	:	405-293-9000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2024
Last Update Date	:	01/29/2024

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Directions to “ DEBORAH RENEE EASTON ” Practice Location

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