Provider Demographics
NPI:1124240627
Name:SHATSWELL, RONEE LYN (LPTA)
Entity type:Individual
Prefix:
First Name:RONEE
Middle Name:LYN
Last Name:SHATSWELL
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 102
Mailing Address - Street 2:
Mailing Address - City:BLAIR
Mailing Address - State:OK
Mailing Address - Zip Code:73526-0102
Mailing Address - Country:US
Mailing Address - Phone:580-477-7226
Mailing Address - Fax:580-481-2379
Practice Address - Street 1:1200 E PECAN ST
Practice Address - Street 2:
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-6141
Practice Address - Country:US
Practice Address - Phone:580-477-7226
Practice Address - Fax:580-481-2379
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK884225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant