Basic Information
| Provider Information | |||||||||
| NPI: | 1679799746 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHIELDS | ||||||||
| FirstName: | CARENZA | ||||||||
| MiddleName: | ANGELINE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2011 W 119TH ST S | ||||||||
| Address2: | |||||||||
| City: | JENKS | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740374380 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056135504 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3030 NW EXPRESSWAY ST STE 809 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731125466 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4059177160 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 1071 | OK | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.