Provider Demographics
NPI:1275547366
Name:SILVER, ROBERT LEE (PT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:LEE
Last Name:SILVER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3905 SE 29TH ST
Mailing Address - Street 2:
Mailing Address - City:DEL CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73115-2639
Mailing Address - Country:US
Mailing Address - Phone:405-670-5569
Mailing Address - Fax:405-670-5571
Practice Address - Street 1:3905 SE 29TH ST
Practice Address - Street 2:
Practice Address - City:DEL CITY
Practice Address - State:OK
Practice Address - Zip Code:73115-2639
Practice Address - Country:US
Practice Address - Phone:405-670-5569
Practice Address - Fax:405-670-5571
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKP.T. 903225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200099720AMedicaid
OK200099720AMedicaid
R11598Medicare UPIN