Healthcare Provider Details

I. General information

NPI: 1073456901
Provider Name (Legal Business Name): CAMMI RODKEY PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 04/14/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 E GLAYDAS
HOOKER OK
73945
US

IV. Provider business mailing address

PO BOX 264
TYRONE OK
73951-0264
US

V. Phone/Fax

Practice location:
  • Phone: 580-652-1111
  • Fax: 580-652-1112
Mailing address:
  • Phone: 580-528-1125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number14-04310
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number3803
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: