Healthcare Provider Details

I. General information

NPI: 1841609781
Provider Name (Legal Business Name): RYAN DOYETO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2014
Last Update Date: 08/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3489 SOUTHRIDGE PL APT 4
TAHLEQUAH OK
74464-7917
US

IV. Provider business mailing address

3489 SOUTHRIDGE PL APT 4
TAHLEQUAH OK
74464-7917
US

V. Phone/Fax

Practice location:
  • Phone: 405-924-1636
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4854
License Number StateOK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: