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NPI Code Detail

MEDICARE: MS. KARA NICOLE LEE P.T.

MEDICARE: MS. KARA NICOLE LEE P.T.
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
1225100000XPhysical TherapistPT2031OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1710899209002OTHEROKBLUE CROSS BLUE SHEILD

General Provider Information

NPI Number : 1629011101
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KARA NICOLE LEE P.T.
Provider Business Mailing Address
First Line : 3705 W MEMORIAL RD
Second Line : SUITE 310
City : OKLAHOMA CITY
State : OK
Zip : 73134-1512
Country : US
Telephone Number : 405-749-6281
Fax Number : 405-936-6496
Provider Business Practice Location Address
First Line : 3705 W MEMORIAL RD
Second Line : SUITE 310
City : OKLAHOMA CITY
State : OK
Zip : 73134-1512
Country : US
Telephone Number : 405-749-6281
Fax Number : 405-936-6496
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2006
Last Update Date : 07/08/2007

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