Provider Demographics
NPI:1760737639
Name:ARANDA, SHELBY KAY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:KAY
Last Name:ARANDA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:KAY
Other - Last Name:LATTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1125 40TH ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:WOODWARD
Mailing Address - State:OK
Mailing Address - Zip Code:73801-1733
Mailing Address - Country:US
Mailing Address - Phone:580-256-2102
Mailing Address - Fax:580-256-1410
Practice Address - Street 1:1125 40TH ST
Practice Address - Street 2:SUITE D
Practice Address - City:WOODWARD
Practice Address - State:OK
Practice Address - Zip Code:73801-1733
Practice Address - Country:US
Practice Address - Phone:580-256-2102
Practice Address - Fax:580-256-1410
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4599225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200442400AMedicaid