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General NPI Number Information
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NPI Number | 1295190593
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Entity Type | Individual
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Provider Name | ROGER DALE WANTLAND RPT
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Gender | Male
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Dates
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Enumeration Date | 12/31/2015
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Last Update Date | 12/31/2015
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Provider Practice Location Address
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Address Line | 1901 PARKWAY DRIVE
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City | ELRENO
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State | OK
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Zip | 73036
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Country | US
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Telephone | 405-262-2608
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Fax | 405-262-2558
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Provider Business Mailing Address
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Address Line | 4350 WILL ROGERS PKWY STE 600
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City | OKLAHOMA CITY
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State | OK
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Zip | 73108-1808
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Country | US
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Telephone | 405-948-2813
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Fax | 405-948-2807
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1850
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License Number State | OK
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