Provider Demographics
NPI:1609868405
Name:FLANARY, RYAN MARC (PT)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:MARC
Last Name:FLANARY
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 1:1742 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICKASHA
Mailing Address - State:OK
Mailing Address - Zip Code:73018-5901
Mailing Address - Country:US
Mailing Address - Phone:405-825-3617
Mailing Address - Fax:405-825-3618
Practice Address - Street 1:2234 W HOUSTON ST STE B
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-3519
Practice Address - Country:US
Practice Address - Phone:918-259-1888
Practice Address - Fax:918-251-3725
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT3136225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200029340AMedicaid
OK249506606Medicare PIN