Provider Demographics
NPI:1497412506
Name:FREEMAN, TAEGAN BRIANNE (AAS-PTA)
Entity type:Individual
Prefix:
First Name:TAEGAN
Middle Name:BRIANNE
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:AAS-PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:OK
Mailing Address - Zip Code:74868-3838
Mailing Address - Country:US
Mailing Address - Phone:405-380-6262
Mailing Address - Fax:
Practice Address - Street 1:101 N POST RD STE A
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-3605
Practice Address - Country:US
Practice Address - Phone:405-397-3550
Practice Address - Fax:405-455-6505
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3475225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty