Provider Demographics
NPI:1245824887
Name:YOUNGBLOOD, DAWN (RPTA)
Entity type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:
Last Name:YOUNGBLOOD
Suffix:
Gender:F
Credentials:RPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12376 LAKEVIEW RD
Mailing Address - Street 2:
Mailing Address - City:SPERRY
Mailing Address - State:OK
Mailing Address - Zip Code:74073-4899
Mailing Address - Country:US
Mailing Address - Phone:918-406-4856
Mailing Address - Fax:
Practice Address - Street 1:13 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:SAND SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:74063-7625
Practice Address - Country:US
Practice Address - Phone:918-246-1436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK514225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant