Provider Demographics
NPI:1245471630
Name:SOWARDS, ROCKY (PT)
Entity type:Individual
Prefix:
First Name:ROCKY
Middle Name:
Last Name:SOWARDS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 268838
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-8838
Mailing Address - Country:US
Mailing Address - Phone:918-619-4400
Mailing Address - Fax:918-619-4652
Practice Address - Street 1:5005 S DARLINGTON AVE # 100
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-7307
Practice Address - Country:US
Practice Address - Phone:918-619-4400
Practice Address - Fax:918-619-4652
Is Sole Proprietor?:No
Enumeration Date:2009-03-13
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4147225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200240710AMedicaid
OK200240710AMedicaid