=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891398939
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOME PHYSICAL THERAPY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/20/2020
-----------------------------------------------------
Last Update Date | 01/19/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 115 N 1ST ST STE 2
-----------------------------------------------------
City | ANADARKO
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73005-2115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-515-9263
-----------------------------------------------------
Fax | 405-515-9019
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23008 COUNTY ROAD 1376
-----------------------------------------------------
City | ANADARKO
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73005-2065
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-515-9263
-----------------------------------------------------
Fax | 405-515-9019
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KATHY KAPPELLE
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 405-933-1548
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------