Active NPI
Brian James Kanelakos, MPT
- Physical Therapist
- Oklahoma City, OK
National Provider Identifier
1124330758
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 4361
- Practice address
- 3705 W Memorial Rd
Suite 301
Oklahoma City, OK 73134-1512 - Phone
- (405) 749-6281
- Fax
- (405) 936-6496
- NPI assigned
- Jul 12, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 4361 | OK | Primary |
Addresses
Primary practice location
3705 W Memorial Rd
Suite 301
Oklahoma City, OK 73134-1512
Mailing address
3705 W Memorial Rd
Suite 301
Oklahoma City, OK 73134-1512
Phone (405) 749-6281
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4361 | OK | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wroe Chiropractic, PA | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
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- NPI 1295946515
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1278892800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1278892800000",
"number": "1124330758",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3705 W MEMORIAL RD",
"address_2": "SUITE 301",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731341512",
"telephone_number": "405-749-6281",
"fax_number": "405-936-6496"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3705 W MEMORIAL RD",
"address_2": "SUITE 301",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731341512",
"telephone_number": "405-749-6281",
"fax_number": "405-936-6496"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KANELAKOS",
"first_name": "BRIAN",
"middle_name": "JAMES",
"credential": "MPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-07-12",
"last_updated": "2010-07-12",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "OK",
"license": "4361",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oklahoma City, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.