Provider Demographics
NPI:1891424180
Name:BREASHEARS, CAILI RENEE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CAILI
Middle Name:RENEE
Last Name:BREASHEARS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:CAILI
Other - Middle Name:RENEE
Other - Last Name:JESTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:10100 HEFNER VILLAGE TER
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-7728
Mailing Address - Country:US
Mailing Address - Phone:918-671-2454
Mailing Address - Fax:
Practice Address - Street 1:1824 COMMONS CIR STE B
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-9538
Practice Address - Country:US
Practice Address - Phone:405-467-6782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-10
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK61562251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK6156OtherFSBPT