Provider Demographics
NPI:1679139547
Name:DORRELL, REBECCA LAINE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:LAINE
Last Name:DORRELL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:REBECCA
Other - Middle Name:LAINE
Other - Last Name:DUPREE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2488 E 81ST ST STE 290
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-4265
Mailing Address - Country:US
Mailing Address - Phone:918-927-3226
Mailing Address - Fax:918-927-3193
Practice Address - Street 1:1071 W BLUE STARR DR STE 105
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-2869
Practice Address - Country:US
Practice Address - Phone:918-283-2992
Practice Address - Fax:918-283-2952
Is Sole Proprietor?:No
Enumeration Date:2019-05-15
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5680225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200842500AMedicaid