Provider Demographics
NPI:1003692336
Name:RAMIREZ, MATTHEW P (PTA)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:P
Last Name:RAMIREZ
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74801-7661
Mailing Address - Country:US
Mailing Address - Phone:630-776-0823
Mailing Address - Fax:
Practice Address - Street 1:101 N POST RD STE A
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-3605
Practice Address - Country:US
Practice Address - Phone:405-397-3550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-04
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3732225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant