Provider Demographics
NPI:1447715446
Name:OKABE, RONALD J (PT)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:J
Last Name:OKABE
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 1:335 HORSESHOE LN
Mailing Address - Street 2:
Mailing Address - City:GRENADA
Mailing Address - State:MS
Mailing Address - Zip Code:38901-6910
Mailing Address - Country:US
Mailing Address - Phone:662-229-7826
Mailing Address - Fax:
Practice Address - Street 1:335 HORSESHOE LN
Practice Address - Street 2:
Practice Address - City:GRENADA
Practice Address - State:MS
Practice Address - Zip Code:38901-6910
Practice Address - Country:US
Practice Address - Phone:662-229-7826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT1795225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist