Active NPI
Russell Allen Fanning, PTA
- Physical Therapy Assistant
- Hydro, OK
National Provider Identifier
1356556955
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 1498
- Practice address
- 800 N. Arapaho
Hydro, OK 73048 - Phone
- (405) 663-2335
- NPI assigned
- May 14, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 Therapy Assistant | 225200000X | 1498 | OK | Primary |
Addresses
Primary practice location
800 N. Arapaho
Hydro, OK 73048
Mailing address
421 N Daniel St
Weatherford, OK 73096-4415
Phone (580) 603-1744
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1498 | OK | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179100800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1356556955",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "421 N DANIEL ST",
"city": "WEATHERFORD",
"state": "OK",
"postal_code": "730964415",
"telephone_number": "580-603-1744"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 N. ARAPAHO",
"city": "HYDRO",
"state": "OK",
"postal_code": "73048",
"telephone_number": "405-663-2335"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FANNING",
"first_name": "RUSSELL",
"middle_name": "ALLEN",
"name_prefix": "Mr.",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "OK",
"license": "1498",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hydro, OK
- Bailey Marie Daugherty
- Deer Creek Pharmacy Inc (Deer Creek Pharmacy)
- Deer Creek Pharmacy Services Inc
- Angelica Maria Exinia, MSW, LCSW
- Faith Christian Fellowship (Care Case Management)
- James Gichuki, MS
- Hydro Medical Clinic PLLC
- Hydro-Eakly Public Schools
- Johna K. Roof, P. C. (Continuing Care and Compounding)
- Jerald Andrew Lee
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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.