Healthcare Provider Details

I. General information

NPI: 1447578273
Provider Name (Legal Business Name): COURTNEY MERLE DEWBRE PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2010
Last Update Date: 02/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 N ROCKFORD RD SUITE C
ARDMORE OK
73401-2540
US

IV. Provider business mailing address

908 N ROCKFORD RD SUITE C
ARDMORE OK
73401-2540
US

V. Phone/Fax

Practice location:
  • Phone: 580-490-3318
  • Fax: 580-490-3312
Mailing address:
  • Phone: 580-490-3318
  • Fax: 580-490-3312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number4555
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: