SHEPHERD MALL THERAPY LLC (NPI# 1285136135) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1285136135 |
Entity Type | Organization |
Organization Name | SHEPHERD MALL THERAPY LLC |
Practice Address |
2401 Nw 23rd St Ste 2d Oklahoma City OK 73107-2420 |
Mailing Address |
4334 Nw Expressway Ste 187 Oklahoma City OK 73116-1515 |
Practice Telephone | 4053553239 |
Practice Fax Number | 4052124270 |
Mailing Fax Number | 4052124270 |
Enumeration Date | 2018-03-07 |
Last Update Date | 2018-03-07 |
Authorized Official Name | DOUGLAS EDWIN BROWN JR. (PRESIDENT) |
Authorized Official Telephone | 4053553239 |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 261QH0700X |
Clinic/Center Specialization: Hearing and Speech |
Ambulatory Health Care Facilities | ||
N | 261QX0100X |
Clinic/Center Specialization: Occupational Medicine |
Ambulatory Health Care Facilities | ||
Y | 261QP2000X |
Clinic/Center Specialization: Physical Therapy |
Ambulatory Health Care Facilities |
Street Address |
2401 NW 23RD ST STE 2D |
City | OKLAHOMA CITY |
State | OK |
Zip Code | 73107-2420 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1154921062 | Erin Bieler | Speech-Language Pathologist | 2401 Nw 23rd St Ste 2d, Oklahoma City, OK 73107-2420 | 2020-10-29 |
1952924490 | Kamree Wackler | Speech-Language Pathologist | 2401 Nw 23rd St Ste 2d, Oklahoma City, OK 73107-2420 | 2020-05-19 |
1548804339 | Reagan Minefee | Speech-Language Pathologist | 2401 Nw 23rd St Ste 2d, Oklahoma City, OK 73107-2420 | 2019-11-05 |
1457918252 | Annelise Luddington | Speech-Language Pathologist | 2401 Nw 23rd St Ste 2d, Oklahoma City, OK 73107-2420 | 2019-05-28 |
1144710062 | Maryorie Montalvo | Speech-Language Pathologist | 2401 Nw 23rd St Ste 2d, Oklahoma City, OK 73107-2420 | 2018-05-16 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1144747999 | Ellen Rose Pochyly | Counselor | 2617 General Pershing Boulevard, Oklahoma City, OK 73107 | 2017-08-23 |
1609399906 | Carrie Ann Moore | Counselor | 2617 General Pershing Blvd., Oklahoma City, OK 73107 | 2017-07-19 |
1821511320 | Diana Lynn Spencer | Counselor | 2617generalpershingblvd, Oklahoma City, OK 73107 | 2017-07-18 |
1861859514 | Catherine Evans | Counselor | 500 N Meridian Ave Ste 409, Oklahoma City, OK 73107 | 2016-01-26 |
1871964551 | Kizzy Frazier | Student in an Organized Health Care Education/Training Program | 1233 N Warren Pl, Oklahoma City, OK 73107 | 2015-10-07 |
1538550629 | Oklahoma Department of Mental Health and Substance Abuse | Case Management | 2625 General Pershing Boulevard, Oklahoma City, OK 73107 | 2015-02-10 |
1952702276 | Andale Healthcare, LLC | Clinic/Center | 2305 N. Meridian, Oklahoma City, OK 73107 | 2014-09-05 |
1114339348 | John Walls | Psychologist | 2012 North Villa Avenue, Oklahoma City, OK 73107 | 2014-05-22 |
1376970517 | Latrice Warrior | Community/Behavioral Health | 2625 General Pershing Drive, Oklahoma City, OK 73107 | 2013-10-02 |
1326485541 | Debra Sue Vaughan | Counselor | 2617 Genral Pershing Blvd, Oklahoma City, OK 73107 | 2013-05-29 |
Find all providers in zip 73107 |
Taxonomy Code | 261QP2000X |
Grouping | Ambulatory Health Care Facilities |
Classification | Clinic/Center |
Specialization | Physical Therapy |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1144821604 | Body Smart Physio LLC | Clinic/Center | 1745a Nw 16th St Ste A, Oklahoma City, OK 73106-2067 | 2020-11-02 |
1497371322 | Leah Diane Spurlock | Clinic/Center | 429 W Wilshire Blvd Ste B, Oklahoma City, OK 73116-7745 | 2020-06-16 |
1134781677 | Peak Solutions, LLC | Clinic/Center | 12401 Trail Oaks Drive, Therapy Room, 2nd Floor, Oklahoma City, OK 73120 | 2019-07-05 |
1851854368 | Physical Therapy Services, LLC | Clinic/Center | 200 N Classen Blvd, Oklahoma City, OK 73106-7627 | 2019-04-11 |
1235658261 | Heinen Physical Therapy, PC | Clinic/Center | 7710 N May Ave, Oklahoma City, OK 73116 | 2017-09-11 |
1841659463 | Peak Solutions, LLC | Clinic/Center | 9400 N Broadway, Suite 120, Oklahoma City, OK 73114-7451 | 2016-02-11 |
1548538655 | Functional Performance Training and Physical Therapy, Pllc | Clinic/Center | 13512 N Eastern Ave, Suite A, Oklahoma City, OK 73131-1812 | 2011-12-02 |
1881998870 | Performax Therapy Services | Clinic/Center | 4334 Nw Expressway Ste 176, Oklahoma City, OK 73116-1550 | 2011-01-05 |
1750691226 | Five Star Physical Therapy and Sport Medicine, LLC | Clinic/Center | 6801 Norht Classen Blvd., Suite #b, Oklahoma City, OK 73116 | 2010-10-18 |
1073777991 | Rehabsource-therapy At Work, LLC | Clinic/Center | 4141 Nw Expressway Ste 325, Oklahoma City, OK 73116-1675 | 2008-07-10 |
Find all providers in OKLAHOMA CITY |
City | OKLAHOMA CITY |
Zip Code | 73107 |
Please comment or provide details below to improve the information on SHEPHERD MALL THERAPY LLC.
Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.