Healthcare Provider Details

I. General information

NPI: 1063752160
Provider Name (Legal Business Name): STETSON ROBERT SCHMITT DPT, OCS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2013
Last Update Date: 03/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5208 W RENO AVE
OKLAHOMA CITY OK
73127-6344
US

IV. Provider business mailing address

4913 W RENO AVE
OKLAHOMA CITY OK
73127-6339
US

V. Phone/Fax

Practice location:
  • Phone: 405-948-4900
  • Fax: 405-948-4933
Mailing address:
  • Phone: 405-948-4900
  • Fax: 405-948-4933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number2012037670
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number6101
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6101
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: