Provider Demographics
NPI:1861006108
Name:KNUDSON, ANNE KATHLEEN (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:KATHLEEN
Last Name:KNUDSON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3009 ASTORIA CT
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-6162
Mailing Address - Country:US
Mailing Address - Phone:405-509-6200
Mailing Address - Fax:
Practice Address - Street 1:1560 W COLT DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001-9108
Practice Address - Country:US
Practice Address - Phone:307-690-1810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYWY-1994225100000X
WYPT-1994225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist