NPIMap

Organization Active NPI

Shepherd Mall Therapy LLC

  • Physical Therapy Clinic/Center
  • Oklahoma City, OK
National Provider Identifier
1285136135
Registry record updated Mar 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
SHEPHERD MALL THERAPY LLC
Practice address
2401 NW 23Rd St Ste 2D
Oklahoma City, OK 73107-2420
Phone
(405) 355-3239
Fax
(405) 212-4270
NPI assigned
Mar 7, 2018
Last updated
Mar 7, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Douglas Edwin Brown Jr.
Title
President
Phone
(405) 355-3239

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Hearing and Speech Clinic/Center 261QH0700X
Physical Therapy Clinic/Center 261QP2000X Primary
Occupational Medicine Clinic/Center 261QX0100X

Addresses

Primary practice location

2401 NW 23Rd St Ste 2D
Oklahoma City, OK 73107-2420

Mailing address

4334 NW Expressway Ste 187
Oklahoma City, OK 73116-1515

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 29

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 29

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1520380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1520380800000",
    "number": "1285136135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4334 NW EXPRESSWAY STE 187",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731161515",
            "fax_number": "405-212-4270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2401 NW 23RD ST STE 2D",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731072420",
            "telephone_number": "405-355-3239",
            "fax_number": "405-212-4270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHEPHERD MALL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-07",
        "last_updated": "2018-03-07",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "EDWIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "405-355-3239",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "261QH0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Hearing and Speech",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QX0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Occupational Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.