Healthcare Provider Details

I. General information

NPI: 1689614216
Provider Name (Legal Business Name): KIMBERLY MICHELLE KNAPP PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 08/16/2022
Certification Date: 08/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6846 S CANTON AVE STE 120
TULSA OK
74136-3413
US

IV. Provider business mailing address

6846 S CANTON AVE STE 120
TULSA OK
74136-3413
US

V. Phone/Fax

Practice location:
  • Phone: 918-806-0106
  • Fax: 918-806-0113
Mailing address:
  • Phone: 918-806-0106
  • Fax: 918-806-0113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2852
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number2852
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: