Provider Demographics
NPI:1699538421
Name:HANSMEYER, KAYTLYN (PT, DPT)
Entity type:Individual
Prefix:
First Name:KAYTLYN
Middle Name:
Last Name:HANSMEYER
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 1:1700 S BROADWAY ST STE E
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-5302
Mailing Address - Country:US
Mailing Address - Phone:405-735-8777
Mailing Address - Fax:
Practice Address - Street 1:1700 S BROADWAY ST STE E
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-5302
Practice Address - Country:US
Practice Address - Phone:405-735-8777
Practice Address - Fax:405-735-8778
Is Sole Proprietor?:No
Enumeration Date:2024-02-05
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6466225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist