MEDICARE: SHAWN ALEXANDRIA HUFFORD HARRISON 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	5813	OK

General Provider Information

NPI Number	:	1508482464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWN ALEXANDRIA HUFFORD HARRISON DPT

Provider Business Mailing Address
First Line	:	321 W BLUERIDGE DR
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73110-3768
Country	:	US
Telephone Number	:	580-330-9003
Fax Number	:

Provider Business Practice Location Address
First Line	:	1124 S DOUGLAS BLVD
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73130-5236
Country	:	US
Telephone Number	:	405-582-2105
Fax Number	:	405-582-2134

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

Provider Enumeration Date	:	06/17/2020
Last Update Date	:	01/13/2021

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