MEDICARE: RYAN MARC FLANARY PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT3136	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609868405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN MARC FLANARY PT

Provider Business Mailing Address
First Line	:	1742 S 4TH ST
Second Line	:
City	:	CHICKASHA
State	:	OK
Zip	:	73018-5901
Country	:	US
Telephone Number	:	405-825-3617
Fax Number	:	405-825-3618

Provider Business Practice Location Address
First Line	:	2234 W HOUSTON ST STE B
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-3519
Country	:	US
Telephone Number	:	918-259-1888
Fax Number	:	918-251-3725

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	11/09/2015

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Directions to “ RYAN MARC FLANARY PT” Practice Location

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