Provider Demographics
NPI:1023038577
Name:ZANTOUT, SAMER IMAD (PT)
Entity type:Individual
Prefix:MR
First Name:SAMER
Middle Name:IMAD
Last Name:ZANTOUT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13801 N BRYANT AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-6440
Mailing Address - Country:US
Mailing Address - Phone:405-286-6080
Mailing Address - Fax:866-594-7004
Practice Address - Street 1:13801 N BRYANT AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-6440
Practice Address - Country:US
Practice Address - Phone:405-286-6080
Practice Address - Fax:866-594-7004
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3789225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist