Basic Information
| Provider Information | |||||||||
| NPI: | 1164940383 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LABETH | ||||||||
| FirstName: | BREE | ||||||||
| MiddleName: | ANNA | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7622 MCLAUGHLIN RD | ||||||||
| Address2: | |||||||||
| City: | PEYTON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 808314710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7194953133 | ||||||||
| FaxNumber: | 7194958685 | ||||||||
| Practice Location | |||||||||
| Address1: | 334 12TH AVE SE STE 130 | ||||||||
| Address2: | |||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730715070 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053106590 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PTL.0015091 | CO | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 6112 | OK | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | PTL.0015091 | 01 | CO | COLORADO STATE PT LICENSE | OTHER |