Provider Demographics
NPI:1619081882
Name:DEAL, JACQUELINE G (PT)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:G
Last Name:DEAL
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 1:9504 E SHADOWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-4173
Mailing Address - Country:US
Mailing Address - Phone:918-343-4199
Mailing Address - Fax:
Practice Address - Street 1:4004 S YALE AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-6017
Practice Address - Country:US
Practice Address - Phone:918-622-4126
Practice Address - Fax:918-270-2398
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1369225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
7464396OtherAETNA