Provider Demographics
NPI:1508435272
Name:TADLOCK, ABBIE RAE (PT, DPT)
Entity type:Individual
Prefix:
First Name:ABBIE
Middle Name:RAE
Last Name:TADLOCK
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 OBSIDIAN DR
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:OK
Mailing Address - Zip Code:73538-3822
Mailing Address - Country:US
Mailing Address - Phone:806-206-7185
Mailing Address - Fax:
Practice Address - Street 1:1401 SOUTHWEST PARK RIDGE BLVD
Practice Address - Street 2:UNIT A
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505
Practice Address - Country:US
Practice Address - Phone:580-730-8015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021021357225100000X
KS11-06731225100000X
OK6645225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist