MEDICARE: KIRSTEN M MCKNIGHT MPT

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	4924	OK

General Provider Information

NPI Number	:	1639502446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRSTEN M MCKNIGHT MPT

Provider Business Mailing Address
First Line	:	200 NW 66TH ST
Second Line	:	SUITE 900
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-8256
Country	:	US
Telephone Number	:	405-840-1957
Fax Number	:	405-840-1052

Provider Business Practice Location Address
First Line	:	200 NW 66TH ST
Second Line	:	SUITE 900
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-8256
Country	:	US
Telephone Number	:	405-840-1957
Fax Number	:	405-840-1052

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

Provider Enumeration Date	:	08/15/2013
Last Update Date	:	07/17/2015

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