Shane Stovall, RPT | |
1405 4th Ave Nw # 296, Ardmore, OK 73401-2708 | |
(580) 795-4768 | |
Not Available |
Full Name | Shane Stovall |
---|---|
Gender | Male |
Speciality | Physical Therapy |
Experience | 27 Years |
Location | 1405 4th Ave Nw # 296, Ardmore, Oklahoma |
Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
Identifier | Type | State | Issuer |
---|---|---|---|
1205929064 | NPI | - | NPPES |
1743403 01 | Medicaid | TX | |
100833900C | Medicaid | OK | |
100833900A | Medicaid | OK |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
225100000X | Physical Therapist | 2905 (Oklahoma) | Primary |
Group Practice Name | Group PECOS PAC ID | No. of Members |
---|---|---|
Summit Rehab Llc | 4486794591 | 7 |
Provider Name | Summit Rehab Llc |
---|---|
Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1447480082 PECOS PAC ID: 4486794591 Enrollment ID: O20091222000314 |
Mailing Address | Practice Location Address |
---|---|
Shane Stovall, RPT 1405 4th Ave Nw # 296, Ardmore, OK 73401-2708 Ph: (580) 795-4768 | Shane Stovall, RPT 1405 4th Ave Nw # 296, Ardmore, OK 73401-2708 Ph: (580) 795-4768 |
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