Provider Demographics
NPI:1588863674
Name:SHRADER, PATRICIA L (RPT)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:L
Last Name:SHRADER
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12899 E 76TH ST N UNIT NO117
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-4026
Mailing Address - Country:US
Mailing Address - Phone:919-609-6003
Mailing Address - Fax:918-609-6002
Practice Address - Street 1:12899 E 76TH ST N UNIT NO117
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-4026
Practice Address - Country:US
Practice Address - Phone:918-609-6003
Practice Address - Fax:918-609-6002
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21562251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics