Provider Demographics
NPI:1205935251
Name:COURCIER, JEFF B (PT)
Entity type:Individual
Prefix:
First Name:JEFF
Middle Name:B
Last Name:COURCIER
Suffix:
Gender:
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14017 N EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-5586
Mailing Address - Country:US
Mailing Address - Phone:405-478-5333
Mailing Address - Fax:405-478-5334
Practice Address - Street 1:14017 N EASTERN AVE
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-5586
Practice Address - Country:US
Practice Address - Phone:405-478-5333
Practice Address - Fax:405-478-5334
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2719225100000X
2251E1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251E1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistElectrophysiology, Clinical
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK2719OtherPT LICENSE
OK200250870AMedicaid
CE20202042OtherHANDS-ON DIAGNOSTICS