Provider Demographics
NPI:1750818720
Name:PENDLETON, ROBERT CATLIN (PTA)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:CATLIN
Last Name:PENDLETON
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 1:525 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:OK
Mailing Address - Zip Code:73096-4403
Mailing Address - Country:US
Mailing Address - Phone:405-757-5694
Mailing Address - Fax:
Practice Address - Street 1:2301 BELL AVE
Practice Address - Street 2:
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-2254
Practice Address - Country:US
Practice Address - Phone:405-757-5694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-21
Last Update Date:2017-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2536225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKH080765781OtherOKLAHOMA DRIVER'S LICENSE