Provider Demographics
NPI:1902018245
Name:MARTIN, RODNEY G (RPTA)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:G
Last Name:MARTIN
Suffix:
Gender:M
Credentials:RPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:971 SW 4TH PL
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-2217
Mailing Address - Country:US
Mailing Address - Phone:405-237-1192
Mailing Address - Fax:
Practice Address - Street 1:1201 HEALTH CENTER PKWY
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-6381
Practice Address - Country:US
Practice Address - Phone:405-717-6979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPTA213225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant