Provider Demographics
NPI:1326576083
Name:GERADS, DEBRA (LMT)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:GERADS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8005 S I 35 SERVICE RD STE 107
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73149-2900
Mailing Address - Country:US
Mailing Address - Phone:405-229-7590
Mailing Address - Fax:
Practice Address - Street 1:4127 NW 122ND ST STE E
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8880
Practice Address - Country:US
Practice Address - Phone:405-229-7590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK173659225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist