Provider Demographics
NPI:1316760838
Name:MCCOLEY-TUTTLE, BROOKLYN DIANE (DPT, PT)
Entity type:Individual
Prefix:
First Name:BROOKLYN
Middle Name:DIANE
Last Name:MCCOLEY-TUTTLE
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3341 S ELM PL
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-7924
Mailing Address - Country:US
Mailing Address - Phone:918-449-1332
Mailing Address - Fax:918-449-8732
Practice Address - Street 1:3341 S ELM PL
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-7924
Practice Address - Country:US
Practice Address - Phone:918-449-1332
Practice Address - Fax:918-449-8732
Is Sole Proprietor?:No
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK6490225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist