Individual provider Active NPI

Gary R Robinson, MS, PT, PCS

  • Pediatric Physical Therapist
  • Tishomingo, OK
National Provider Identifier
1154538445
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Physical TherapistTaxonomy code 2251P0200X
License
1108 Issued in OK
Practice address
One Murray Campus
Nah #108
Tishomingo, OK 73460-0391
Phone
(580) 310-4314
Fax
(580) 371-9844
NPI assigned
May 17, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Physical Therapist 2251P0200X 1108 OK Primary

Addresses

Primary practice location

One Murray Campus
Nah #108
Tishomingo, OK 73460-0391

Mailing address

PO Box 391
Tishomingo, OK 73460-0391
Phone (580) 310-4314

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240415002380 OK Practitioner - Physical Therapist in Private Practice 6507205242 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
1108OKMDPediatric Physical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Summit Rehab LLC CurrentSince Mar 1, 2024 Accepting new patients

Locations

1107 W Broadway St
Ardmore, OK 73401
Phone (580) 226-5566

1405 4th Ave NW
Ardmore, OK 73401
Phone (580) 226-5566

307 4th Ave SE
Ardmore, OK 73401
Phone (580) 300-3010

105 N 5th Ave
Ste A
Madill, OK 73446
Phone (580) 872-4277

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1154538445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 391",
            "city": "TISHOMINGO",
            "state": "OK",
            "postal_code": "734600391",
            "telephone_number": "580-310-4314",
            "fax_number": "580-371-9844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "ONE MURRAY CAMPUS",
            "address_2": "NAH #108",
            "city": "TISHOMINGO",
            "state": "OK",
            "postal_code": "734600391",
            "telephone_number": "580-310-4314",
            "fax_number": "580-371-9844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBINSON",
        "first_name": "GARY",
        "middle_name": "R",
        "credential": "MS, PT, PCS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "OK",
            "license": "1108",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tishomingo, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.