Provider Demographics
NPI:1508482464
Name:HUFFORD HARRISON, SHAWN ALEXANDRIA (DPT)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:ALEXANDRIA
Last Name:HUFFORD HARRISON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 W BLUERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-3768
Mailing Address - Country:US
Mailing Address - Phone:580-330-9003
Mailing Address - Fax:
Practice Address - Street 1:1124 S DOUGLAS BLVD
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-5236
Practice Address - Country:US
Practice Address - Phone:405-582-2105
Practice Address - Fax:405-582-2134
Is Sole Proprietor?:No
Enumeration Date:2020-06-17
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5813225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist