Provider Demographics
NPI:1770132953
Name:TURNER BUMGARNER, KATIE (DPT)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:TURNER BUMGARNER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:MARIE
Other - Last Name:TURNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2234 W HOUSTON ST STE B
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-3519
Mailing Address - Country:US
Mailing Address - Phone:918-259-1888
Mailing Address - Fax:918-251-3725
Practice Address - Street 1:536 E 6TH ST
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-5520
Practice Address - Country:US
Practice Address - Phone:918-756-6060
Practice Address - Fax:918-756-6058
Is Sole Proprietor?:No
Enumeration Date:2019-09-10
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5152225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200879280AMedicaid
OK5152OtherLICENSE