Healthcare Provider Details

I. General information

NPI: 1447254826
Provider Name (Legal Business Name): DENA MARIE BRUNK PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7877 S SHERIDAN RD
TULSA OK
74133-3456
US

IV. Provider business mailing address

7877 S SHERIDAN RD
TULSA OK
74133-3456
US

V. Phone/Fax

Practice location:
  • Phone: 918-492-1618
  • Fax: 918-492-1813
Mailing address:
  • Phone: 918-492-1618
  • Fax: 918-496-1813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4062
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: