MEDICARE: MR. MICHAEL SHANE SIMS MPT, OCS, FAAOMPT

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	3751	OK

General Provider Information

NPI Number	:	1528046596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL SHANE SIMS MPT, OCS, FAAOMPT

Provider Business Mailing Address
First Line	:	1410 FRETZ DR
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73003-5782
Country	:	US
Telephone Number	:	405-285-8477
Fax Number	:	405-285-8499

Provider Business Practice Location Address
First Line	:	1410 FRETZ DR
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73003-5782
Country	:	US
Telephone Number	:	405-285-8477
Fax Number	:	405-285-8499

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

Provider Enumeration Date	:	01/09/2006
Last Update Date	:	03/06/2008

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