Provider Demographics
NPI:1063721215
Name:PAPE, DARIN E (DPT)
Entity type:Individual
Prefix:
First Name:DARIN
Middle Name:E
Last Name:PAPE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9309 E RENO AVE
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-3321
Mailing Address - Country:US
Mailing Address - Phone:405-732-3353
Mailing Address - Fax:405-732-3397
Practice Address - Street 1:9309 E RENO AVE
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-3321
Practice Address - Country:US
Practice Address - Phone:405-732-3353
Practice Address - Fax:405-732-3397
Is Sole Proprietor?:No
Enumeration Date:2010-10-05
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4379225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200311120AMedicaid
OK500522047Medicare PIN