MEDICARE: KRISTI KMETZ DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	4842	OK

General Provider Information

NPI Number	:	1336548312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTI KMETZ DPT

Provider Business Mailing Address
First Line	:	5220 S NEW HAVEN AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74135-3920
Country	:	US
Telephone Number	:	918-697-4174
Fax Number	:

Provider Business Practice Location Address
First Line	:	2417 E 53RD ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74105-6600
Country	:	US
Telephone Number	:	918-712-8412
Fax Number	:	918-712-8413

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2014
Last Update Date	:	08/15/2014

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Directions to “ KRISTI KMETZ DPT” Practice Location

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