Provider Demographics
NPI:1922806959
Name:STUBBS, GREGORY R
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:R
Last Name:STUBBS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 CODY ST
Mailing Address - Street 2:
Mailing Address - City:LONE GROVE
Mailing Address - State:OK
Mailing Address - Zip Code:73443-6101
Mailing Address - Country:US
Mailing Address - Phone:580-465-6018
Mailing Address - Fax:
Practice Address - Street 1:2510 CHICKASAW BLVD
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-1341
Practice Address - Country:US
Practice Address - Phone:580-222-2840
Practice Address - Fax:580-222-2841
Is Sole Proprietor?:No
Enumeration Date:2025-03-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2441225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant