Provider Demographics
NPI:1992075691
Name:COPELAND, BREAH SHEA (DPT)
Entity type:Individual
Prefix:
First Name:BREAH
Middle Name:SHEA
Last Name:COPELAND
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:BREAH
Other - Middle Name:SHEA
Other - Last Name:NICOLET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2488 E 81ST ST STE 290
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-4265
Mailing Address - Country:US
Mailing Address - Phone:918-927-3737
Mailing Address - Fax:918-927-3193
Practice Address - Street 1:6585 S YALE AVE STE 310
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-8334
Practice Address - Country:US
Practice Address - Phone:918-502-4700
Practice Address - Fax:918-502-4701
Is Sole Proprietor?:No
Enumeration Date:2012-01-11
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4317225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200413200AMedicaid