MEDICARE: KYNSIE GOGGANS

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	6305	OK

General Provider Information

NPI Number	:	1518700707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYNSIE GOGGANS

Provider Business Mailing Address
First Line	:	13142 RED OAK DR
Second Line	:
City	:	CHOCTAW
State	:	OK
Zip	:	73020-6246
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2801 PARKLAWN DR STE 504
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73110-4232
Country	:	US
Telephone Number	:	558-240-5455
Fax Number	:

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

Provider Enumeration Date	:	06/14/2024
Last Update Date	:	06/14/2024

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Directions to “ KYNSIE GOGGANS ” Practice Location

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