Healthcare Provider Details

I. General information

NPI: 1225222375
Provider Name (Legal Business Name): KIMBERLY DEANN BEDNAR PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2007
Last Update Date: 04/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14024 QUAIL POINTE DR
OKLAHOMA CITY OK
73134-1006
US

IV. Provider business mailing address

14024 QUAIL POINTE DR
OKLAHOMA CITY OK
73134-1006
US

V. Phone/Fax

Practice location:
  • Phone: 405-340-2025
  • Fax: 405-340-6649
Mailing address:
  • Phone: 405-340-2025
  • Fax: 405-340-6649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4027
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: