Provider Demographics
NPI:1376266353
Name:HANSHEW, TRACEY DEANN (RPT)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:DEANN
Last Name:HANSHEW
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:TRACEY
Other - Middle Name:DEANN
Other - Last Name:SANDISON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1717 CLEARWATER DR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-4341
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2701 S 9TH ST
Practice Address - Street 2:
Practice Address - City:CHICKASHA
Practice Address - State:OK
Practice Address - Zip Code:73018-6744
Practice Address - Country:US
Practice Address - Phone:405-224-3593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2385261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy