Provider Demographics
NPI:1649489592
Name:CALDWELL, KENNETH H (PT)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:H
Last Name:CALDWELL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 MCDONALD DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-4358
Mailing Address - Country:US
Mailing Address - Phone:405-216-5236
Mailing Address - Fax:
Practice Address - Street 1:EDMOND PHYSICAL THERAPY
Practice Address - Street 2:301 S. BRYANT, ASHLING SQUARE, BLDG. B-100
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034
Practice Address - Country:US
Practice Address - Phone:405-340-2019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3834225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist