Provider Demographics
NPI:1245821099
Name:BROWN, KYLE TIMOTHY (PT, DPT, OCS, CSCS)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:TIMOTHY
Last Name:BROWN
Suffix:
Gender:M
Credentials:PT, DPT, OCS, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 E AIRPORT RD # 1118
Mailing Address - Street 2:
Mailing Address - City:OKMULGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74447-9082
Mailing Address - Country:US
Mailing Address - Phone:918-756-9211
Mailing Address - Fax:
Practice Address - Street 1:900 E AIRPORT RD
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-9082
Practice Address - Country:US
Practice Address - Phone:918-756-9211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
OK5043225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist