Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 3143 | OK |
NPI | 1013563485 |
---|---|
Provider Name | Kylee Michaela Johnston |
First Address | Norman, OK 73072-2287 |
Second Address | Oklahoma City, OK 73116-9126 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2019 |
Last Update Date | 12/08/2019 |