Provider Demographics
NPI:1831523414
Name:SAMBURG, JEFFREY DAVID (PT, DPT, MS, OCS)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:DAVID
Last Name:SAMBURG
Suffix:
Gender:M
Credentials:PT, DPT, MS, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4004 CEDAR PASS DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73179-4702
Mailing Address - Country:US
Mailing Address - Phone:630-292-2761
Mailing Address - Fax:
Practice Address - Street 1:4004 CEDAR PASS DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73179-4702
Practice Address - Country:US
Practice Address - Phone:630-292-2761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-30
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5855225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist