Provider Demographics
NPI:1669660452
Name:MARKHAM, JANNA KAYLENE (PT)
Entity Type:Individual
Prefix:
First Name:JANNA
Middle Name:KAYLENE
Last Name:MARKHAM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 146
Mailing Address - Street 2:
Mailing Address - City:REYDON
Mailing Address - State:OK
Mailing Address - Zip Code:73660-9780
Mailing Address - Country:US
Mailing Address - Phone:580-497-6066
Mailing Address - Fax:
Practice Address - Street 1:4350 WILL ROGERS PKWY STE 600
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73108-1808
Practice Address - Country:US
Practice Address - Phone:405-948-2813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT3074225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist