Provider Demographics
NPI:1942856042
Name:STOCKTON, DANIEL (RPTA)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:STOCKTON
Suffix:
Gender:M
Credentials:RPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 N BAILEY ST
Mailing Address - Street 2:
Mailing Address - City:PRYOR
Mailing Address - State:OK
Mailing Address - Zip Code:74361-4201
Mailing Address - Country:US
Mailing Address - Phone:918-824-7770
Mailing Address - Fax:918-824-6307
Practice Address - Street 1:111 N BAILEY ST
Practice Address - Street 2:
Practice Address - City:PRYOR
Practice Address - State:OK
Practice Address - Zip Code:74361-4201
Practice Address - Country:US
Practice Address - Phone:918-824-7770
Practice Address - Fax:918-824-6307
Is Sole Proprietor?:No
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK264225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant