Individual
LACEY R FAIRBROTHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
14890 SE 29TH ST, CHOCTAW, OK 73020-3515
(405) 390-1731
(405) 390-1981
Mailing address
14890 SE 29TH ST, CHOCTAW, OK 73020-3515
(405) 390-1731
(405) 390-1981
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4499
OK
Other
Enumeration date
09/23/2011
Last updated
07/06/2015
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