Provider Demographics
NPI:1972924926
Name:DOFFLEMEYER, JACQULYN (DPT)
Entity Type:Individual
Prefix:
First Name:JACQULYN
Middle Name:
Last Name:DOFFLEMEYER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10400 E APPLE VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73151-9470
Mailing Address - Country:US
Mailing Address - Phone:405-990-0947
Mailing Address - Fax:
Practice Address - Street 1:10400 E APPLE VALLEY RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73151-9470
Practice Address - Country:US
Practice Address - Phone:405-990-0947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-18
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4118225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist