Provider Demographics
NPI:1891196622
Name:MAYOTTE, LISA-ANN L (PT)
Entity Type:Individual
Prefix:
First Name:LISA-ANN
Middle Name:L
Last Name:MAYOTTE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 MCGEE DR
Mailing Address - Street 2:SUITE 113
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-5774
Mailing Address - Country:US
Mailing Address - Phone:405-202-4112
Mailing Address - Fax:405-360-8888
Practice Address - Street 1:1300 MCGEE DR
Practice Address - Street 2:SUITE 113
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-5774
Practice Address - Country:US
Practice Address - Phone:405-202-4112
Practice Address - Fax:405-360-8888
Is Sole Proprietor?:No
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1432225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist