Provider Demographics
NPI:1447487319
Name:JOHNSON, KARA M (PT)
Entity type:Individual
Prefix:MRS
First Name:KARA
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7608 E 91ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-6014
Mailing Address - Country:US
Mailing Address - Phone:918-663-0606
Mailing Address - Fax:918-663-8754
Practice Address - Street 1:7608 E 91ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-6014
Practice Address - Country:US
Practice Address - Phone:918-663-0606
Practice Address - Fax:918-663-8754
Is Sole Proprietor?:No
Enumeration Date:2009-06-17
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4335225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK4335OtherPHYSICAL THERAPY STATE LICENSE NUMBER
TX1168147OtherPHYSICAL THERAPY STATE LICENSE NUMBER