Individual
SHAWN M SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1700 S BROADWAY ST, STE B, MOORE, OK 73160-5300
(405) 735-8777
(405) 735-8778
Mailing address
336 NE 145TH PL, EDMOND, OK 73013-2152
(405) 286-4469
(405) 242-6486
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT3210
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OKAAA0373
MEDICARE, PTAN
OK
Enumeration date
12/13/2006
Last updated
05/22/2018
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