Provider Demographics
NPI:1285610824
Name:MAYES, SHAWN CHRISTOPHER (PT)
Entity type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:CHRISTOPHER
Last Name:MAYES
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2424 E 21ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-1711
Mailing Address - Country:US
Mailing Address - Phone:918-743-9235
Mailing Address - Fax:918-743-9234
Practice Address - Street 1:2234 W HOUSTON ST STE B
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-3519
Practice Address - Country:US
Practice Address - Phone:918-259-9522
Practice Address - Fax:918-251-3725
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK3104225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200242950AMedicaid
OKOKA102623Medicare PIN