Provider Demographics
NPI:1730397662
Name:GATZMAN, SIDNEY JOSEPH (RPT)
Entity type:Individual
Prefix:
First Name:SIDNEY
Middle Name:JOSEPH
Last Name:GATZMAN
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30352 SCR 4410RD
Mailing Address - Street 2:
Mailing Address - City:STIGLER
Mailing Address - State:OK
Mailing Address - Zip Code:74462
Mailing Address - Country:US
Mailing Address - Phone:918-967-3547
Mailing Address - Fax:918-967-3547
Practice Address - Street 1:30352 SCR 4410RD
Practice Address - Street 2:
Practice Address - City:STIGLER
Practice Address - State:OK
Practice Address - Zip Code:74462
Practice Address - Country:US
Practice Address - Phone:918-967-3547
Practice Address - Fax:918-967-3547
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT2323225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist