Provider Demographics
NPI:1639373574
Name:ADE, RYAN DOUGLAS (PT, ATC)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:DOUGLAS
Last Name:ADE
Suffix:
Gender:M
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 NW 6TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73106-7241
Mailing Address - Country:US
Mailing Address - Phone:405-609-3667
Mailing Address - Fax:580-609-3697
Practice Address - Street 1:1500 N 10TH ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:OK
Practice Address - Zip Code:73542-1421
Practice Address - Country:US
Practice Address - Phone:580-335-6642
Practice Address - Fax:580-335-6607
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4312255A2300X
OK3077225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer