Healthcare Provider Details

I. General information

NPI: 1851526263
Provider Name (Legal Business Name): COURCIER CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2009
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 TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT2719
License Number StateOK

VIII. Authorized Official

Name: JEFF B COURCIER
Title or Position: PRESIDENT
Credential: PT
Phone: 405-478-5333