MEDICARE: SHIRLEY J BRISTER PT

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	454	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760443485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIRLEY J BRISTER PT

Provider Business Mailing Address
First Line	:	1809 E 13TH ST
Second Line	:	SUITE 100
City	:	TULSA
State	:	OK
Zip	:	74104-4419
Country	:	US
Telephone Number	:	918-582-6800
Fax Number	:

Provider Business Practice Location Address
First Line	:	1809 E 13TH ST
Second Line	:	SUITE 100
City	:	TULSA
State	:	OK
Zip	:	74104-4419
Country	:	US
Telephone Number	:	918-582-6800
Fax Number	:

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

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	08/20/2013

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