Active NPI
Robert Distefano, PT
- Physical Therapist
- Edmond, OK
National Provider Identifier
1225201221
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT1535
- Practice address
- 1717 W 33Rd St
Edmond, OK 73013-3819 - Phone
- (405) 330-3500
- NPI assigned
- Apr 10, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT1535 | OK | Primary |
Addresses
Primary practice location
1717 W 33Rd St
Edmond, OK 73013-3819
Mailing address
1717 W 33Rd St
Edmond, OK 73013-3819
Phone (405) 330-3500
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT1535 | OK | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Comprehensive Therapy Services, Inc. | Physical Therapist | Past | Accepting new patients |
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.
-
- Physical Therapist
- Edmond, OK
- NPI 1235156035
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1207785600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1207785600000",
"number": "1225201221",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1717 W 33RD ST",
"city": "EDMOND",
"state": "OK",
"postal_code": "730133819",
"telephone_number": "405-330-3500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1717 W 33RD ST",
"city": "EDMOND",
"state": "OK",
"postal_code": "730133819",
"telephone_number": "405-330-3500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DISTEFANO",
"first_name": "ROBERT",
"name_prefix": "Mr.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-04-10",
"last_updated": "2008-04-10",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "OK",
"license": "PT1535",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Edmond, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.