MEDICARE: RYAN HALEY PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	5971	OK

General Provider Information

NPI Number	:	1447829304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN HALEY PT

Provider Business Mailing Address
First Line	:	800 NW 6TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73106-7241
Country	:	US
Telephone Number	:	405-609-3667
Fax Number	:	405-609-3697

Provider Business Practice Location Address
First Line	:	1507 BROOKWOOD AVE
Second Line	:
City	:	DUNCAN
State	:	OK
Zip	:	73533-1356
Country	:	US
Telephone Number	:	580-252-9459
Fax Number	:	580-255-2158

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2021
Last Update Date	:	06/23/2021

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Directions to “ RYAN HALEY PT” Practice Location

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