Provider Demographics
NPI:1992006597
Name:SCHMIDT, KOURTNEY KAY (DPT)
Entity Type:Individual
Prefix:
First Name:KOURTNEY
Middle Name:KAY
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KOURTNEY
Other - Middle Name:KAY
Other - Last Name:KIMMELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3610 SE HUNTINGTON CIR
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-8445
Mailing Address - Country:US
Mailing Address - Phone:580-353-1190
Mailing Address - Fax:580-353-1006
Practice Address - Street 1:3610 SE HUNTINGTON CIR
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-8445
Practice Address - Country:US
Practice Address - Phone:580-353-1190
Practice Address - Fax:580-353-1006
Is Sole Proprietor?:No
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4358225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist