Provider Demographics
NPI:1831276518
Name:MCSOUD, CHRISTIAN LEE I (RPT)
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:LEE
Last Name:MCSOUD
Suffix:I
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:CHRISTIAN
Other - Middle Name:
Other - Last Name:BURTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPT
Mailing Address - Street 1:7018 S UTICA AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3907
Mailing Address - Country:US
Mailing Address - Phone:918-744-1001
Mailing Address - Fax:918-744-9729
Practice Address - Street 1:7018 S UTICA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-3907
Practice Address - Country:US
Practice Address - Phone:918-744-1001
Practice Address - Fax:918-744-9729
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3567225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOK701073Medicare PIN