MEDICARE: MRS. SHAHANDEH NAEL PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1653	OK

General Provider Information

NPI Number	:	1134303753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHAHANDEH NAEL PT

Provider Business Mailing Address
First Line	:	5028 S 165TH EAST AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74134-7186
Country	:	US
Telephone Number	:	918-398-0707
Fax Number	:	918-398-8269

Provider Business Practice Location Address
First Line	:	5028 S 165TH EAST AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74134-7186
Country	:	US
Telephone Number	:	918-398-0707
Fax Number	:	918-398-8269

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2007
Last Update Date	:	12/18/2007

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