Healthcare Provider Details

I. General information

NPI: 1679496194
Provider Name (Legal Business Name): SOPHIA STOUT DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2026
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3345 S HARVARD AVE STE 101
TULSA OK
74135-1800
US

IV. Provider business mailing address

3007 W BERWICK
CLAREMORE OK
74017-4847
US

V. Phone/Fax

Practice location:
  • Phone: 918-574-2575
  • Fax:
Mailing address:
  • Phone: 918-720-6233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: