Gage W Park, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5808 Issued in OK

Practice address

165 Steve Barry Blvd
Pryor, OK 74361-6841

Phone

(918) 824-4500

Fax

(918) 824-1977

NPI assigned

Jun 11, 2020

Last updated

Jun 11, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mountain Valley Therapy, Inc

  • Physical Therapist
  • La Grande, OR
  • NPI 1659353035
  Medicare reassignment NPD
• Drayer Physical Therapy Oklahoma LLC

  • Physical Therapist
  • Skiatook, OK
  • NPI 1316345705
  NPD
• Drayer Physical Therapy Oklahoma LLC

  • Physical Therapist
  • Pryor, OK
  • NPI 1346798147
  NPD
• Drayer Physical Therapy Oklahoma LLC

  • Physical Therapist
  • Glenpool, OK
  • NPI 1861054454
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1591833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591833600000",
    "number": "1073138434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8205 PRESIDENTS DR",
            "city": "HUMMELSTOWN",
            "state": "PA",
            "postal_code": "170368621",
            "telephone_number": "717-839-2188",
            "fax_number": "717-565-1104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "165 STEVE BARRY BLVD",
            "city": "PRYOR",
            "state": "OK",
            "postal_code": "743616841",
            "telephone_number": "918-824-4500",
            "fax_number": "918-824-1977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "GAGE",
        "middle_name": "W",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-06-11",
        "last_updated": "2020-06-11",
        "certification_date": "2020-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OK",
            "license": "5808",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Johnie Louis Owens III, D.O.
• Nicole Owens
• Lacey Rheann Pace
• Alyson Eseleta Padilla
• Richard Benjamin Palmer, B.A., M.S.
• Jamie Parker
• Crystal Noel Parrett
• Deanna L Parsons, CMT
• Jacob Ray Paul
• Jennifer Paul

• Physical Therapist in Pryor, OK
• Providers in Pryor, OK by specialty
• Physical Therapist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.