Provider Demographics
NPI:1326528332
Name:FRALEY, RYAN (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:FRALEY
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3929 24TH AVE SE APT 10
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-0813
Mailing Address - Country:US
Mailing Address - Phone:712-389-7013
Mailing Address - Fax:
Practice Address - Street 1:34637 AIRLINE RD
Practice Address - Street 2:
Practice Address - City:PAULS VALLEY
Practice Address - State:OK
Practice Address - Zip Code:73075-8583
Practice Address - Country:US
Practice Address - Phone:405-238-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-19
Last Update Date:2018-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5565225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist