Provider Demographics
NPI:1710615273
Name:MEARS, KENNEDY SHEA (PT)
Entity type:Individual
Prefix:
First Name:KENNEDY
Middle Name:SHEA
Last Name:MEARS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KENNEDY
Other - Middle Name:SHEA
Other - Last Name:MEARS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3400 W TECUMSEH RD STE 101
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-1810
Mailing Address - Country:US
Mailing Address - Phone:405-360-6764
Mailing Address - Fax:
Practice Address - Street 1:2201 TRAE YOUNG DR STE 105
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-5092
Practice Address - Country:US
Practice Address - Phone:405-515-8080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-11
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK61862251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty