Provider Demographics
NPI:1184400343
Name:ABRAM, DEVAUGHN (PT)
Entity type:Individual
Prefix:
First Name:DEVAUGHN
Middle Name:
Last Name:ABRAM
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3125 N SOONER RD STE 150
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-8333
Mailing Address - Country:US
Mailing Address - Phone:405-285-9659
Mailing Address - Fax:405-920-6070
Practice Address - Street 1:3125 N SOONER RD STE 150
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-8333
Practice Address - Country:US
Practice Address - Phone:405-285-9659
Practice Address - Fax:405-920-6070
Is Sole Proprietor?:No
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6416225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist