Provider Demographics
NPI:1265746127
Name:RANALLO, JENNIFER K (PT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:K
Last Name:RANALLO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:K
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:221 E COMANCHE AVE
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-5845
Mailing Address - Country:US
Mailing Address - Phone:918-423-1181
Mailing Address - Fax:918-423-1191
Practice Address - Street 1:221 E COMANCHE AVE
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-5845
Practice Address - Country:US
Practice Address - Phone:918-423-1181
Practice Address - Fax:918-423-1191
Is Sole Proprietor?:No
Enumeration Date:2010-08-03
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4353225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200300530AMedicaid