Healthcare Provider Details

I. General information

NPI: 1265430268
Provider Name (Legal Business Name): TAMARA LYNN BRINLEE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 03/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N BRYANT AVE
EDMOND OK
73034-3206
US

IV. Provider business mailing address

9600 BROADWAY EXT
OKLAHOMA CITY OK
73114-7408
US

V. Phone/Fax

Practice location:
  • Phone: 405-230-9230
  • Fax: 405-330-5591
Mailing address:
  • Phone: 405-230-9000
  • Fax: 405-230-9157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number3023
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: