Healthcare Provider Details

I. General information

NPI: 1467373167
Provider Name (Legal Business Name): BROOKE BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12400 S HIWASSEE RD
OKLAHOMA CITY OK
73165-7681
US

IV. Provider business mailing address

1054 COUNTY ROAD 1240
POCASSET OK
73079-8233
US

V. Phone/Fax

Practice location:
  • Phone: 405-862-6065
  • Fax:
Mailing address:
  • Phone: 405-862-6065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: