Provider Demographics
NPI:1407012115
Name:ANESHANSLEY, AUTUMN NICOLE (MPT)
Entity Type:Individual
Prefix:MS
First Name:AUTUMN
Middle Name:NICOLE
Last Name:ANESHANSLEY
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3732 S LOUISVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2244
Mailing Address - Country:US
Mailing Address - Phone:580-302-0571
Mailing Address - Fax:
Practice Address - Street 1:3838 50TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79413-3808
Practice Address - Country:US
Practice Address - Phone:806-792-5522
Practice Address - Fax:806-785-7582
Is Sole Proprietor?:No
Enumeration Date:2008-08-01
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4099225100000X
TX1225532225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist