Provider Demographics
NPI:1447578273
Name:DEWBRE, COURTNEY MERLE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:MERLE
Last Name:DEWBRE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 N ROCKFORD RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-2540
Mailing Address - Country:US
Mailing Address - Phone:580-490-3318
Mailing Address - Fax:580-490-3312
Practice Address - Street 1:908 N ROCKFORD RD
Practice Address - Street 2:SUITE C
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-2540
Practice Address - Country:US
Practice Address - Phone:580-490-3318
Practice Address - Fax:580-490-3312
Is Sole Proprietor?:No
Enumeration Date:2010-05-04
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK45552251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200425070AMedicaid
TX550673YXZKMedicare PIN