Healthcare Provider Details

I. General information

NPI: 1336068782
Provider Name (Legal Business Name): LANDON W TUBBS PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 N 19TH AVE BLDG 4
DURANT OK
74701-3017
US

IV. Provider business mailing address

37742 STATE ROAD 78
DURANT OK
74701-8260
US

V. Phone/Fax

Practice location:
  • Phone: 580-931-3300
  • Fax: 580-931-3301
Mailing address:
  • Phone: 580-931-3300
  • Fax: 580-931-3301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number7103
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: