Provider Demographics
NPI:1689614216
Name:KNAPP, KIMBERLY MICHELLE (PT)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:MICHELLE
Last Name:KNAPP
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 1:6846 S CANTON AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3413
Mailing Address - Country:US
Mailing Address - Phone:918-806-0106
Mailing Address - Fax:918-806-0113
Practice Address - Street 1:6846 S CANTON AVE STE 120
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-3413
Practice Address - Country:US
Practice Address - Phone:918-806-0106
Practice Address - Fax:918-806-0113
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2852225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100834710Medicaid