Provider Demographics
NPI:1366445488
Name:RELYEA, DERRIEN (PT)
Entity Type:Individual
Prefix:MS
First Name:DERRIEN
Middle Name:
Last Name:RELYEA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 N SANTA FE AVE
Mailing Address - Street 2:STE B
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-9126
Mailing Address - Country:US
Mailing Address - Phone:405-840-2903
Mailing Address - Fax:405-840-3256
Practice Address - Street 1:6400 N SANTA FE AVE
Practice Address - Street 2:STE B
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-9126
Practice Address - Country:US
Practice Address - Phone:405-840-2903
Practice Address - Fax:405-840-3256
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2774225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T1600OtherBCBS PAR PLAN PROVIDER #
TX8T1600OtherBCBS BLUE LINK PROVIDER #
TX8B3200Medicare PIN