Provider Demographics
NPI:1134158629
Name:KNAPP, KYLE DOUGLAS (PT)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:DOUGLAS
Last Name:KNAPP
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 S ELM PL
Mailing Address - Street 2:SUITE 460
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-7877
Mailing Address - Country:US
Mailing Address - Phone:918-451-1100
Mailing Address - Fax:918-451-0082
Practice Address - Street 1:2950 S ELM PL
Practice Address - Street 2:SUITE 460
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-7877
Practice Address - Country:US
Practice Address - Phone:918-451-1100
Practice Address - Fax:918-451-0082
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2645225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
5202899OtherCIGNA
7611583OtherAETNA
5202899OtherCIGNA