Provider Demographics
NPI:1750353181
Name:MATHIS, TIPHANIE S (PT)
Entity type:Individual
Prefix:MRS
First Name:TIPHANIE
Middle Name:S
Last Name:MATHIS
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 1:801 NW 63RD ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-7603
Mailing Address - Country:US
Mailing Address - Phone:405-879-9997
Mailing Address - Fax:405-879-3397
Practice Address - Street 1:801 NW 63RD ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-7603
Practice Address - Country:US
Practice Address - Phone:405-879-9997
Practice Address - Fax:405-879-3397
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT 2926225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200097800AMedicaid
OK370203Medicare Oscar/Certification
OK249506704Medicare ID - Type Unspecified
OKOK404507Medicare PIN