Provider Demographics
NPI:1417178955
Name:MAYFIELD, DENISE RAE (RPTA)
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:RAE
Last Name:MAYFIELD
Suffix:
Gender:F
Credentials:RPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24206 E 116TH ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74014-7771
Mailing Address - Country:US
Mailing Address - Phone:918-449-1356
Mailing Address - Fax:
Practice Address - Street 1:3000 S ELM PL
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-7917
Practice Address - Country:US
Practice Address - Phone:918-451-5143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKTA109225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant