Provider Demographics
NPI:1508083932
Name:BREEDLOVE, SHIRLEY JEAN
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:JEAN
Last Name:BREEDLOVE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 E FOLEY ST
Mailing Address - Street 2:PO BOX 937
Mailing Address - City:EUFAULA
Mailing Address - State:OK
Mailing Address - Zip Code:74432-3019
Mailing Address - Country:US
Mailing Address - Phone:918-618-6874
Mailing Address - Fax:918-618-6868
Practice Address - Street 1:49 E FOLEY ST
Practice Address - Street 2:
Practice Address - City:EUFAULA
Practice Address - State:OK
Practice Address - Zip Code:74432-3019
Practice Address - Country:US
Practice Address - Phone:918-618-6874
Practice Address - Fax:918-618-6868
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1093225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist