Provider Demographics
NPI:1033833850
Name:REDDOUT, DEBORAH (PT, DPT)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:REDDOUT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:EDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3004 W UNIVERSITY BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-2999
Mailing Address - Country:US
Mailing Address - Phone:918-619-5125
Mailing Address - Fax:
Practice Address - Street 1:3004 W UNIVERSITY BLVD STE 101
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-2999
Practice Address - Country:US
Practice Address - Phone:918-619-5125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1363859225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist