Healthcare Provider Details

I. General information

NPI: 1891909719
Provider Name (Legal Business Name): STEPHEN GREGORY RYAN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8801 S 101ST EAST AVE
TULSA OK
74133-5716
US

IV. Provider business mailing address

11765 S CANTON AVE
TULSA OK
74137-8403
US

V. Phone/Fax

Practice location:
  • Phone: 918-294-4060
  • Fax: 918-294-4067
Mailing address:
  • Phone: 918-369-9373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 3735
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: