Provider Demographics
NPI:1003394636
Name:SMITH, KAREN RAE (PT)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:RAE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:KAREN
Other - Middle Name:RAE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8222 S YALE AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-2296
Mailing Address - Country:US
Mailing Address - Phone:918-493-1200
Mailing Address - Fax:918-752-5343
Practice Address - Street 1:8222 S YALE AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-2296
Practice Address - Country:US
Practice Address - Phone:918-493-1200
Practice Address - Fax:918-752-5343
Is Sole Proprietor?:No
Enumeration Date:2018-08-06
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18202251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics