Healthcare Provider Details

I. General information

NPI: 1831646561
Provider Name (Legal Business Name): SCOTT RYAN MARTIN DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2016
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 GARTH BROOKS BLVD
YUKON OK
73099-4106
US

IV. Provider business mailing address

700 NW 7TH ST
OKLAHOMA CITY OK
73102-1212
US

V. Phone/Fax

Practice location:
  • Phone: 405-354-6698
  • Fax:
Mailing address:
  • Phone: 405-609-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5163
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: