Provider Demographics
NPI:1174972475
Name:MATLOCK, SHELBY BROOK (DPT)
Entity type:Individual
Prefix:MISS
First Name:SHELBY
Middle Name:BROOK
Last Name:MATLOCK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:BROOK
Other - Last Name:JUREK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:3400 S DOUGLAS BLVD STE 306
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73150-1001
Mailing Address - Country:US
Mailing Address - Phone:405-772-4535
Mailing Address - Fax:405-772-4537
Practice Address - Street 1:3400 S DOUGLAS BLVD STE 306
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73150-1001
Practice Address - Country:US
Practice Address - Phone:405-772-4535
Practice Address - Fax:405-772-4537
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-07
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1275676225100000X
OK5536225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist