Active NPI
Mary Lee Stephens, PT
- Pediatric Physical Therapist
- Jenks, OK
National Provider Identifier
1205045812
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Physical Therapist
- License
- PT650
- Practice address
- 205 E B St
Jenks Public Schools
Jenks, OK 74037-3906 - Phone
- (918) 299-4415
- Fax
- (918) 298-6647
- NPI assigned
- May 21, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Physical Therapist | 2251P0200X | PT650 | OK | Primary |
Addresses
Primary practice location
205 E B St
Jenks Public Schools
Jenks, OK 74037-3906
Mailing address
11933 E 126TH St
Broken Arrow, OK 74011-5230
Phone (918) 369-3008
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT650 | OK | MD | Pediatric Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179705600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1205045812",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11933 E 126TH ST",
"city": "BROKEN ARROW",
"state": "OK",
"postal_code": "740115230",
"telephone_number": "918-369-3008"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "205 E B ST",
"address_2": "JENKS PUBLIC SCHOOLS",
"city": "JENKS",
"state": "OK",
"postal_code": "740373906",
"telephone_number": "918-299-4415",
"fax_number": "918-298-6647"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STEPHENS",
"first_name": "MARY",
"middle_name": "LEE",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2251P0200X",
"taxonomy_group": "",
"desc": "Physical Therapist, Pediatrics",
"state": "OK",
"license": "PT650",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jenks, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.