Provider Demographics
NPI:1376834895
Name:MOODY, KATHERINE JEAN (RPT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:JEAN
Last Name:MOODY
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:JEAN
Other - Last Name:REIMER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPT
Mailing Address - Street 1:1001 SW A AVE
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-3951
Mailing Address - Country:US
Mailing Address - Phone:580-353-8900
Mailing Address - Fax:580-353-8903
Practice Address - Street 1:1001 SW A AVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-3951
Practice Address - Country:US
Practice Address - Phone:580-353-8900
Practice Address - Fax:580-353-8903
Is Sole Proprietor?:No
Enumeration Date:2011-05-02
Last Update Date:2023-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT21192251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics