Basic Information
| Provider Information | |||||||||
| NPI: | 1770132953 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TURNER | ||||||||
| FirstName: | KATIE | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2234 W HOUSTON ST STE B | ||||||||
| Address2: | |||||||||
| City: | BROKEN ARROW | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740123519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9182591888 | ||||||||
| FaxNumber: | 9182513725 | ||||||||
| Practice Location | |||||||||
| Address1: | 536 E 6TH ST | ||||||||
| Address2: | |||||||||
| City: | OKMULGEE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 744475520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9187566060 | ||||||||
| FaxNumber: | 9187566058 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2019 | ||||||||
| LastUpdateDate: | 03/13/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 03/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 5152 | OK | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 200879280A | 05 | OK | MEDICAID | 5152 | 01 | OK | LICENSE | OTHER |