Doctor Name: | DR. SHAWN G WALLACE |
NPI Number: | 1457323396 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PT, DPT |
License Number: | PT1769 |
Business Practice Address: | 13390 Ne 23rd St Choctaw, OK - 730208622 |
Business Phone Number: | 4057695555 |
Business Fax Number: | 4057695558 |
Mailing Address: | 13390 Ne 23rd St, CHOCTAW |
State: | OK |
Postal Code: | 730208622 |
Phone Number: | 4057695555 |
Fax Number: | 4057695558 |
NPI Enumeration Date: | 02/05/2006 |
NPI Last Update Date: | 09/10/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | PT1769 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |