Provider Demographics
NPI:1396428959
Name:KNIGHT, KATELYN (PTA)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7541 S MINGO RD APT 9117
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-3391
Mailing Address - Country:US
Mailing Address - Phone:580-716-8941
Mailing Address - Fax:
Practice Address - Street 1:14002 E 21ST ST STE 650
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74134-1432
Practice Address - Country:US
Practice Address - Phone:918-274-7902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3674225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant