Provider Demographics
NPI:1821036617
Name:FRIEBUS, STEVEN DEAN (MED, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:DEAN
Last Name:FRIEBUS
Suffix:
Gender:M
Credentials:MED, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 W NATCHEZ ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74011-4525
Mailing Address - Country:US
Mailing Address - Phone:918-451-6928
Mailing Address - Fax:
Practice Address - Street 1:3027 S NEW HAVEN AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-6131
Practice Address - Country:US
Practice Address - Phone:918-746-6452
Practice Address - Fax:918-746-6182
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3112255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer