Provider Demographics
NPI:1386780690
Name:SHIVE, KIRSTIE LEA (MSPT)
Entity type:Individual
Prefix:MS
First Name:KIRSTIE
Middle Name:LEA
Last Name:SHIVE
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:825 N BROADWAY AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-6039
Mailing Address - Country:US
Mailing Address - Phone:405-609-3670
Mailing Address - Fax:405-605-8638
Practice Address - Street 1:301 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-5507
Practice Address - Country:US
Practice Address - Phone:580-477-3305
Practice Address - Fax:580-477-2423
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT2808225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist