Healthcare Provider Details

I. General information

NPI: 1477984318
Provider Name (Legal Business Name): RONDA A SWANK PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2013
Last Update Date: 12/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 NW 12TH ST
OKLAHOMA CITY OK
73106-6802
US

IV. Provider business mailing address

815 NW 12TH ST
OKLAHOMA CITY OK
73106-6802
US

V. Phone/Fax

Practice location:
  • Phone: 405-230-9575
  • Fax: 405-228-2569
Mailing address:
  • Phone: 405-230-9575
  • Fax: 405-228-2569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2195
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: