Healthcare Provider Details

I. General information

NPI: 1619081882
Provider Name (Legal Business Name): JACQUELINE G DEAL P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 10/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4004 S YALE AVE
TULSA OK
74135-6017
US

IV. Provider business mailing address

9504 E SHADOWBROOK DR
CLAREMORE OK
74017-4173
US

V. Phone/Fax

Practice location:
  • Phone: 918-622-4126
  • Fax: 918-270-2398
Mailing address:
  • Phone: 918-343-4199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1369
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: