Healthcare Provider Details

I. General information

NPI: 1336063676
Provider Name (Legal Business Name): MYKAELA KING PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 S ADAMS ST
JENKS OK
74037-2573
US

IV. Provider business mailing address

240 S ADAMS ST
JENKS OK
74037-2573
US

V. Phone/Fax

Practice location:
  • Phone: 918-409-0157
  • Fax:
Mailing address:
  • Phone: 918-409-0157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number7144
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: