Individual
MRS. DENA MARIE BRUNK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
7877 S SHERIDAN RD, TULSA, OK 74133-3456
(918) 492-1618
(918) 492-1813
Mailing address
7877 S SHERIDAN RD, TULSA, OK 74133-3456
(918) 492-1618
(918) 496-1813
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4062
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200119040A
MEDICAID LEGACY
OK
05
—
200119040A
—
OK
01
—
243729114
MEDICARE
OK
01
—
731212096001
BCBS LEGACY/PROVIDER
OK
Enumeration date
06/13/2005
Last updated
09/14/2022
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