Provider Demographics
NPI:1952683211
Name:TUGGLE, RICHARD DWAIN (RPT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:DWAIN
Last Name:TUGGLE
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2417 E 53RD ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-6601
Mailing Address - Country:US
Mailing Address - Phone:918-712-8412
Mailing Address - Fax:918-712-8413
Practice Address - Street 1:2417 E 53RD ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-6601
Practice Address - Country:US
Practice Address - Phone:918-712-8412
Practice Address - Fax:918-712-8413
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist