Provider Demographics
NPI:1407227846
Name:LAKEPOINTE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:LAKEPOINTE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:SHAHAN-HALE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:405-507-0110
Mailing Address - Street 1:4013 NW EXPRESSWAY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-2610
Mailing Address - Country:US
Mailing Address - Phone:405-507-0110
Mailing Address - Fax:405-507-0111
Practice Address - Street 1:4013 NW EXPRESSWAY
Practice Address - Street 2:SUITE 120
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-2610
Practice Address - Country:US
Practice Address - Phone:405-507-0110
Practice Address - Fax:405-507-0111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-12
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT2690261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy