Provider Demographics
NPI:1285730978
Name:LANDES, KATIE ANN (PT)
Entity type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:ANN
Last Name:LANDES
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:PO BOX 3675
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-3675
Mailing Address - Country:US
Mailing Address - Phone:405-214-0300
Mailing Address - Fax:405-214-0301
Practice Address - Street 1:2506 N. HARRISON
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804
Practice Address - Country:US
Practice Address - Phone:405-214-0300
Practice Address - Fax:405-214-0301
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3634225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
70-0522179Medicare ID - Type Unspecified