MEDICARE: JACQULYN DOFFLEMEYER DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	4118	OK

General Provider Information

NPI Number	:	1972924926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQULYN DOFFLEMEYER DPT

Provider Business Mailing Address
First Line	:	10400 E APPLE VALLEY RD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73151-9470
Country	:	US
Telephone Number	:	405-990-0947
Fax Number	:

Provider Business Practice Location Address
First Line	:	10400 E APPLE VALLEY RD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73151-9470
Country	:	US
Telephone Number	:	405-990-0947
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2013
Last Update Date	:	12/18/2013

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