Provider Demographics
NPI:1104222991
Name:CAMPANELL, SHARI LYN (PT)
Entity Type:Individual
Prefix:MRS
First Name:SHARI
Middle Name:LYN
Last Name:CAMPANELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1131 S NORFOLK AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74120-5009
Mailing Address - Country:US
Mailing Address - Phone:918-403-9238
Mailing Address - Fax:
Practice Address - Street 1:1414 S DENVER AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74119-3423
Practice Address - Country:US
Practice Address - Phone:918-712-7805
Practice Address - Fax:918-712-7813
Is Sole Proprietor?:No
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3864225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist