Healthcare Provider Details

I. General information

NPI: 1356790208
Provider Name (Legal Business Name): BRIANA M ZUTA PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2016
Last Update Date: 08/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1623 S UTICA AVE
TULSA OK
74104
US

IV. Provider business mailing address

1623 S UTICA AVE
TULSA OK
74104-4909
US

V. Phone/Fax

Practice location:
  • Phone: 918-982-6800
  • Fax: 918-231-6973
Mailing address:
  • Phone: 918-982-6800
  • Fax: 918-743-6109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5098
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: