Provider Demographics
NPI:1831684794
Name:FLOYD, KIRSTEN MELISSA (PT, DPT)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:MELISSA
Last Name:FLOYD
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 S BOULEVARD STE A1
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-5490
Mailing Address - Country:US
Mailing Address - Phone:405-513-8118
Mailing Address - Fax:405-513-6490
Practice Address - Street 1:3500 S BOULEVARD STE A1
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-5490
Practice Address - Country:US
Practice Address - Phone:405-513-8118
Practice Address - Fax:405-513-6490
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-24
Last Update Date:2018-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5101225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist