Provider Demographics
NPI:1487420840
Name:JOUBERT, ELIZABETH MARGARETHA
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:MARGARETHA
Last Name:JOUBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:MARGARETHA
Other - Last Name:OOSTHUYSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11312 W CARRIER RD
Mailing Address - Street 2:
Mailing Address - City:CARRIER
Mailing Address - State:OK
Mailing Address - Zip Code:73727-5006
Mailing Address - Country:US
Mailing Address - Phone:580-747-6169
Mailing Address - Fax:
Practice Address - Street 1:11312 W CARRIER RD
Practice Address - Street 2:
Practice Address - City:CARRIER
Practice Address - State:OK
Practice Address - Zip Code:73727-5006
Practice Address - Country:US
Practice Address - Phone:580-747-6169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-28
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5934225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist