Provider Demographics
NPI:1386243491
Name:LATHAM, KERRY LEIGH (PT, DPT)
Entity type:Individual
Prefix:MISS
First Name:KERRY
Middle Name:LEIGH
Last Name:LATHAM
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:MRS
Other - First Name:KERRY
Other - Middle Name:LEIGH
Other - Last Name:LATHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2509 KINGS WAY
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-3633
Mailing Address - Country:US
Mailing Address - Phone:817-729-5476
Mailing Address - Fax:
Practice Address - Street 1:6201 N SANTA FE AVE STE 1000
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-7532
Practice Address - Country:US
Practice Address - Phone:405-272-5450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-20
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5608225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist