Healthcare Provider Details

I. General information

NPI: 1205935251
Provider Name (Legal Business Name): JEFF B. COURCIER P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14017 N EASTERN AVE
EDMOND OK
73013-5586
US

IV. Provider business mailing address

14017 N EASTERN AVE
EDMOND OK
73013-5586
US

V. Phone/Fax

Practice location:
  • Phone: 405-478-5333
  • Fax: 405-478-5334
Mailing address:
  • Phone: 405-478-5333
  • Fax: 405-478-5334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2719
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code2251E1300X
TaxonomyClinical Electrophysiology Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: