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General NPI Number Information
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NPI Number | 1063715530
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Entity Type | Organization
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Legal Business Name | JOURNEYS PHYSICAL THERAPY, PLLC
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Dates
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Enumeration Date | 12/06/2010
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Last Update Date | 12/06/2010
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Provider Practice Location Address
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Address Line | 1200 S SHUNDI
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City | GROVE
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State | OK
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Zip | 74344-1014
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Country | US
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Telephone | 918-353-2309
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Fax | 918-787-7889
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Provider Business Mailing Address
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Address Line | PO BOX 450517
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City | GROVE
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State | OK
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Zip | 74345-0517
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Country | US
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Telephone | 918-353-2309
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Fax | 918-787-7889
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Authorized Official
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Title or Position | PHYSICAL THERAPIST/ OWNER
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Name | SHANNON RATERMANN
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Credential | PT, DPT
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Telephone | 918-353-2309
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 3886
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License Number State | OK
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