Provider Demographics
NPI:1194758052
Name:EPPERSON, CHRISTY DEANN (PT, GCS)
Entity type:Individual
Prefix:MS
First Name:CHRISTY
Middle Name:DEANN
Last Name:EPPERSON
Suffix:
Gender:F
Credentials:PT, GCS
Other - Prefix:MS
Other - First Name:CHRISTY
Other - Middle Name:DEANN
Other - Last Name:RACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, GCS
Mailing Address - Street 1:604 VILLAGE BLVD
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-1924
Mailing Address - Country:US
Mailing Address - Phone:580-916-6096
Mailing Address - Fax:580-745-9467
Practice Address - Street 1:604 VILLAGE BLVD
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-1924
Practice Address - Country:US
Practice Address - Phone:580-916-6096
Practice Address - Fax:580-745-9467
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT2356225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100835420AMedicaid