Provider Demographics
NPI:1558148270
Name:STAFFORD, SHARON MARIE (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:MARIE
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 N CLASSEN BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73106-7440
Mailing Address - Country:US
Mailing Address - Phone:405-587-0000
Mailing Address - Fax:
Practice Address - Street 1:6421 S MILLER BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-1605
Practice Address - Country:US
Practice Address - Phone:405-587-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK938225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist