Elizabeth Agre, PT, DPT
Individual provider Active NPI Physical Therapist · Fort Defiance, AZ
NPI 1891268280 · NPPES record last updated May 28, 2025
Key facts
- NPI
- 1891268280
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 5572 (OK)
- Practice address
- Corner of Route N12 and N7
Fort Defiance, AZ 86504-0649 - Phone
- (928) 729-8000
- NPI assigned
- Jan 8, 2019
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TX, OK
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230707001055 | TX | Practitioner - Physical Therapist in Private Practice | 1658730734 | Reassigns benefits to 1 organization |
| I20230919003664 | OK | Practitioner - Physical Therapist in Private Practice | 1658730734 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5572 | OK | MD | Dentist |
| 27299 | MD | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Powerback Rehabilitation LLC | Physical Therapist | Current |
Accepting new patients |
| Powerback Rehabilitation LLC | Physical Therapist | Current |
Accepting new patients |
| Oklahoma Luna Care Physical Therapy LLC | Physical Therapist | Current |
Accepting new patients |
Locations
501 SE Flower Mound Rd
Lawton, OK 73501
Phone (580) 351-6511
1776 E Robinson St
Norman, OK 73071
Phone (405) 360-5600
3030 NW Expressway St
Ste 300
Oklahoma City, OK 73112
Phone (405) 326-7287
101 E State St
Kennett Square, PA 19348
Phone (610) 925-4436
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 27299 | MD | |
| Physical Therapist | 225100000X | 5572 | OK | Yes |
Addresses
Primary practice location
Corner of Route N12 and N7
Fort Defiance, AZ 86504-0649
Mailing address
PO Box 649
Fort Defiance, AZ 86504-0649
Phone (928) 729-8000
Other providers in Fort Defiance, AZ
- Tamelyn Adakai-Daniel
- Walter Max Adam
- Jamie S Adams
- Margaret Adams
- Sandra L.S. Adkins
- Dante Naigan Agustin Jr.
- Mohammad Akhavan Heidari
- Oluwabukola Akinsiku
- Christina Marie Alexander
- Jerome Brian Alford
All providers in Fort Defiance, AZ · Physical Therapist in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 28, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.