Tyler Austin Rolette, D.P.T.
Individual provider Active NPI Physical Therapist · Stroud, OK
NPI 1386070530 · NPPES record last updated Sep 19, 2013
Key facts
- NPI
- 1386070530
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 4708 (OK)
- Practice address
- 356110 E 930 Rd
Stroud, OK 74079-5184 - Phone
- (918) 968-9531
- Fax
- (918) 968-1532
- NPI assigned
- Sep 19, 2013
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Sac and Fox Nation
Practice addresses (Care Compare)
356110 E 930 Rd
Stroud, OK 74079-5184
Phone 91896895313035
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140109001690 | OK | Practitioner - Physical Therapist in Private Practice | 6305074790 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4708 | OK | MD | Anesthesiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sac & Fox Nation | Current |
Accepting new patients |
Locations
356110 E 930 Rd
Stroud, OK 74079
Phone (918) 968-9531
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 4708 | OK | Yes |
Addresses
Primary practice location
356110 E 930 Rd
Stroud, OK 74079-5184
Mailing address
356110 E 930 Rd
Stroud, OK 74079-5184
Phone (918) 968-9531
Other providers in Stroud, OK
- Paloma Reyes
- Rha Stroud Inc
- Rha Stroud Inc
- Jane Rich
- Sarah Ruth Ann Roe
- Bethany Carolee Rollins
- Rural Wellness Stroud Clinic Inc
- Rural Wellness Stroud Inc.
- Rural Wellness Stroud Inc.
- Rural Wellness Stroud Inc.
All providers in Stroud, OK · Physical Therapist in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 19, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.