Provider Demographics
NPI:1164940383
Name:LABETH, BREE ANNA (DPT)
Entity Type:Individual
Prefix:
First Name:BREE
Middle Name:ANNA
Last Name:LABETH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7622 MCLAUGHLIN RD
Mailing Address - Street 2:
Mailing Address - City:PEYTON
Mailing Address - State:CO
Mailing Address - Zip Code:80831-4710
Mailing Address - Country:US
Mailing Address - Phone:719-495-3133
Mailing Address - Fax:719-495-8685
Practice Address - Street 1:334 12TH AVE SE STE 130
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-5070
Practice Address - Country:US
Practice Address - Phone:405-310-6590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0015091225100000X
OK6112225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPTL.0015091OtherCOLORADO STATE PT LICENSE