MEDICARE: MISS SHELBY BROOK MATLOCK DPT

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	1275676	TX
2	225100000X	Physical Therapist	5536	OK

General Provider Information

NPI Number	:	1174972475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS SHELBY BROOK MATLOCK DPT

Provider Business Mailing Address
First Line	:	3400 S DOUGLAS BLVD STE 306
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73150-1001
Country	:	US
Telephone Number	:	405-772-4535
Fax Number	:	405-772-4537

Provider Business Practice Location Address
First Line	:	3400 S DOUGLAS BLVD STE 306
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73150-1001
Country	:	US
Telephone Number	:	405-772-4535
Fax Number	:	405-772-4537

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

Provider Enumeration Date	:	06/07/2016
Last Update Date	:	10/14/2021

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