Provider Demographics
NPI:1801600275
Name:RANSOM, HUNTER DERRIN LEE (PTA)
Entity type:Individual
Prefix:MR
First Name:HUNTER
Middle Name:DERRIN LEE
Last Name:RANSOM
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 1:21112 S SHILOH RD
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74019-6414
Mailing Address - Country:US
Mailing Address - Phone:918-803-2609
Mailing Address - Fax:
Practice Address - Street 1:1500 N SIOUX AVE
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-3128
Practice Address - Country:US
Practice Address - Phone:918-923-4700
Practice Address - Fax:918-923-4701
Is Sole Proprietor?:No
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3888225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant