Provider Demographics
NPI:1124446257
Name:JUDEH, SHAKIRA (PT)
Entity type:Individual
Prefix:
First Name:SHAKIRA
Middle Name:
Last Name:JUDEH
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 1:1712 HUNTERS RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-1835
Mailing Address - Country:US
Mailing Address - Phone:405-275-1668
Mailing Address - Fax:405-275-1668
Practice Address - Street 1:1712 HUNTERS RIDGE DR
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-1835
Practice Address - Country:US
Practice Address - Phone:405-275-1668
Practice Address - Fax:405-275-1668
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-05
Last Update Date:2014-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3482225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist