Healthcare Provider Details

I. General information

NPI: 1164940383
Provider Name (Legal Business Name): BREE ANNA LABETH DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2017
Last Update Date: 07/21/2022
Certification Date: 12/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

334 12TH AVE SE STE 130
NORMAN OK
73071-5070
US

IV. Provider business mailing address

7622 MCLAUGHLIN RD
PEYTON CO
80831-4710
US

V. Phone/Fax

Practice location:
  • Phone: 405-310-6590
  • Fax:
Mailing address:
  • Phone: 719-495-3133
  • Fax: 719-495-8685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0015091
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6112
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: