1780816363 NPI number — MRS. BROOKE A. HERRINGTON D.P.T.

Table of content: MRS. BROOKE A. HERRINGTON D.P.T. (NPI 1780816363)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780816363 NPI number — MRS. BROOKE A. HERRINGTON D.P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERRINGTON
Provider First Name:
BROOKE
Provider Middle Name:
A.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
D.P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ARCHER
Provider Other First Name:
BROOKE
Provider Other Middle Name:
A.
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1780816363
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4812 E 33RD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TULSA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74135-2038
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-622-4126
Provider Business Mailing Address Fax Number:
918-270-2398

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 N MAIN ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
SAND SPRINGS
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74063-7650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-245-0111
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/17/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  4266 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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