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General NPI Number Information
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NPI Number | 1902967698
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Entity Type | Individual
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Provider Name | SHAWN M SMITH PT
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Gender | Male
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 05/22/2018
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Provider Practice Location Address
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Address Line | 1700 S BROADWAY ST STE B
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City | MOORE
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State | OK
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Zip | 73160-5300
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Country | US
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Telephone | 405-735-8777
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Fax | 405-735-8778
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Provider Business Mailing Address
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Address Line | 336 NE 145TH PL
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City | EDMOND
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State | OK
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Zip | 73013-2152
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Country | US
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Telephone | 405-286-4469
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Fax | 405-242-6486
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | PT3210
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License Number State | OK
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