Active NPI
Kaitlyn Richardson
- Physical Therapy Assistant
- Madill, OK
National Provider Identifier
1154187946
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 3744
- Practice address
- 410 W Lillie Blvd
Madill, OK 73446-1270 - Phone
- (580) 872-4277
- Fax
- (580) 872-4261
- NPI assigned
- Feb 28, 2024
- Sex
- Female
- 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 Therapy Assistant | 225200000X | 3744 | OK | Primary |
Addresses
Primary practice location
410 W Lillie Blvd
Madill, OK 73446-1270
Mailing address
1405 4TH Ave NW # 296
Ardmore, OK 73401-2708
Phone (580) 226-5566
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3744 | OK | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Summit Rehab LLC | Physical Therapy Assistant | Current | Accepting new patients |
Locations
1405 4th Ave NW
Ardmore, OK 73401
Phone (580) 226-5566
410 W Lillie Blvd
Madill, OK 73446
Phone (580) 226-5566
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1709078400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1709078400000",
"number": "1154187946",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1405 4TH AVE NW # 296",
"city": "ARDMORE",
"state": "OK",
"postal_code": "734012708",
"telephone_number": "580-226-5566"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "410 W LILLIE BLVD",
"city": "MADILL",
"state": "OK",
"postal_code": "734461270",
"telephone_number": "580-872-4277",
"fax_number": "580-872-4261"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RICHARDSON",
"first_name": "KAITLYN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-02-28",
"last_updated": "2024-02-28",
"certification_date": "2024-02-28",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "OK",
"license": "3744",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Madill, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.