Healthcare Provider Details

I. General information

NPI: 1548006414
Provider Name (Legal Business Name): ZACHARY BROOKS DPT, PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2024
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3341 S ELM PL
BROKEN ARROW OK
74012-7924
US

IV. Provider business mailing address

3341 S ELM PL
BROKEN ARROW OK
74012-7924
US

V. Phone/Fax

Practice location:
  • Phone: 918-449-1332
  • Fax: 918-449-8732
Mailing address:
  • Phone: 918-449-1332
  • Fax: 918-449-8732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP060152T
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2026030734
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberLPT-033632
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: