Provider Demographics
NPI:1639334568
Name:EGELSTON, SHYLIA DANAE (MPT)
Entity Type:Individual
Prefix:MS
First Name:SHYLIA
Middle Name:DANAE
Last Name:EGELSTON
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3705 W MEMORIAL RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-1512
Mailing Address - Country:US
Mailing Address - Phone:405-749-6281
Mailing Address - Fax:405-936-6496
Practice Address - Street 1:3705 W MEMORIAL RD
Practice Address - Street 2:SUITE 310
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-1512
Practice Address - Country:US
Practice Address - Phone:405-749-6281
Practice Address - Fax:405-936-6496
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT41282251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic