Provider Demographics
NPI:1639499635
Name:SHAHAN, TERI MICHELE (RPT)
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:MICHELE
Last Name:SHAHAN
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4013 NW EXPRESSWAY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-2610
Mailing Address - Country:US
Mailing Address - Phone:405-507-0110
Mailing Address - Fax:405-507-0111
Practice Address - Street 1:4013 NW EXPRESSWAY
Practice Address - Street 2:SUITE 120
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-2610
Practice Address - Country:US
Practice Address - Phone:405-507-0110
Practice Address - Fax:405-507-0111
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-02
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2690225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK900522326Medicare PIN
OK364152YTP1Medicare PIN