Provider Demographics
NPI:1518682228
Name:KOLMAN, STEPHANIE LYNNE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LYNNE
Last Name:KOLMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11431 S 67TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:BIXBY
Mailing Address - State:OK
Mailing Address - Zip Code:74008-8238
Mailing Address - Country:US
Mailing Address - Phone:918-760-2311
Mailing Address - Fax:
Practice Address - Street 1:11431 S 67TH EAST AVE
Practice Address - Street 2:
Practice Address - City:BIXBY
Practice Address - State:OK
Practice Address - Zip Code:74008-8238
Practice Address - Country:US
Practice Address - Phone:918-760-2311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-05
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT18312251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics