Healthcare Provider Details

I. General information

NPI: 1396660460
Provider Name (Legal Business Name): MEGAN RENEA BURKETT PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1165 BRENNER RD
SAPULPA OK
74066-6141
US

IV. Provider business mailing address

2237 W QUINTON ST
BROKEN ARROW OK
74011-4505
US

V. Phone/Fax

Practice location:
  • Phone: 918-224-0600
  • Fax:
Mailing address:
  • Phone: 918-269-8460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number4243
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: