MEDICARE: MRS. BROOKE A. HERRINGTON D.P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	4266	OK

General Provider Information

NPI Number	:	1780816363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BROOKE A. HERRINGTON D.P.T.

Provider Business Mailing Address
First Line	:	4812 E 33RD ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74135-2038
Country	:	US
Telephone Number	:	918-622-4126
Fax Number	:	918-270-2398

Provider Business Practice Location Address
First Line	:	200 N MAIN ST
Second Line	:	SUITE C
City	:	SAND SPRINGS
State	:	OK
Zip	:	74063-7650
Country	:	US
Telephone Number	:	918-245-0111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2009
Last Update Date	:	06/20/2012

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