Healthcare Provider Details

I. General information

NPI: 1689672727
Provider Name (Legal Business Name): ROBERT G CARUSO PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 12/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2236 W MAIN ST
NORMAN OK
73069-6462
US

IV. Provider business mailing address

825 N BROADWAY AVE SUITE 400
OKLAHOMA CITY OK
73102-6039
US

V. Phone/Fax

Practice location:
  • Phone: 405-321-5969
  • Fax: 405-321-5967
Mailing address:
  • Phone: 405-609-3697
  • Fax: 405-605-8638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberAT172
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT2090
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: