Provider Demographics
NPI:1750595187
Name:SCARBOROUGH, BROOKLYN MICHELLE (RPT)
Entity type:Individual
Prefix:
First Name:BROOKLYN
Middle Name:MICHELLE
Last Name:SCARBOROUGH
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 4TH AVE NW # 296
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-2708
Mailing Address - Country:US
Mailing Address - Phone:580-795-4561
Mailing Address - Fax:
Practice Address - Street 1:7711 E 111TH ST
Practice Address - Street 2:SUITE 127
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-2570
Practice Address - Country:US
Practice Address - Phone:918-629-8462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2886225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist