Provider Demographics
NPI:1447602958
Name:SHIMANEK, EVAN NICOLE (PT)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:NICOLE
Last Name:SHIMANEK
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 1:3700 36TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-1803
Mailing Address - Country:US
Mailing Address - Phone:405-230-9675
Mailing Address - Fax:405-230-9680
Practice Address - Street 1:3700 36TH AVE NW
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-1803
Practice Address - Country:US
Practice Address - Phone:405-230-9675
Practice Address - Fax:405-230-9680
Is Sole Proprietor?:No
Enumeration Date:2016-07-08
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5158225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist