Provider Demographics
NPI:1831337955
Name:COURCIER, MELINDA CARLENE (RPT)
Entity type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:CARLENE
Last Name:COURCIER
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:MISS
Other - First Name:MELINDA
Other - Middle Name:
Other - Last Name:WELLS
Other - Suffix:
Other - Last Name Type:Former Name
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:2009-01-27
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT2720174400000X
OKOK2720225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200785740AMedicaid
OKOK2720OtherPT