Provider Demographics
NPI:1245410810
Name:KILLMAN, LADAWNA J (RPT)
Entity Type:Individual
Prefix:MISS
First Name:LADAWNA
Middle Name:J
Last Name:KILLMAN
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:MRS
Other - First Name:LADAWNA
Other - Middle Name:J
Other - Last Name:GOSNELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPT
Mailing Address - Street 1:11704 S VINE ST
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-4342
Mailing Address - Country:US
Mailing Address - Phone:918-299-7118
Mailing Address - Fax:
Practice Address - Street 1:11704 S VINE ST
Practice Address - Street 2:
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-4342
Practice Address - Country:US
Practice Address - Phone:918-299-7118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-12
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT2338225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist