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NPI Code Detail

MEDICARE: MS. AUTUMN NICOLE ANESHANSLEY MPT

MEDICARE: MS. AUTUMN NICOLE ANESHANSLEY MPT
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
1225100000XPhysical Therapist4099OK
2225100000XPhysical Therapist1225532TX

General Provider Information

NPI Number : 1407012115
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. AUTUMN NICOLE ANESHANSLEY MPT
Provider Business Mailing Address
First Line : 3732 S LOUISVILLE AVE
Second Line :
City : TULSA
State : OK
Zip : 74135-2244
Country : US
Telephone Number : 580-302-0571
Fax Number :
Provider Business Practice Location Address
First Line : 3838 50TH ST
Second Line :
City : LUBBOCK
State : TX
Zip : 79413-3808
Country : US
Telephone Number : 806-792-5522
Fax Number : 806-785-7582
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2008
Last Update Date : 06/11/2018

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Directions to “ MS. AUTUMN NICOLE ANESHANSLEY MPT” Practice Location

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