Paul J. Labreche Jr., D.C., P.T.
Individual provider Active NPI Physical Therapist · Owasso, OK
NPI 1275786642 · NPPES record last updated Aug 25, 2021
Key facts
- NPI
- 1275786642
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 4574 (OK)
- Practice address
- Elite Performance & Rehabilitation
12806 E. 101St Place N.
Owasso, OK 74055 - Phone
- (918) 376-4243
- Fax
- (918) 376-4249
- NPI assigned
- Oct 29, 2008
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2008
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Aldridge and Dust Enterprises Inc.
Practice addresses (Care Compare)
12806 E 101St PL N
Owasso, OK 74055-4662
Phone (918) 376-4243
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in OK
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130507000261 | OK | Practitioner - Chiropractic | 1658353552 | Reassigns benefits to 1 organization |
| I20131011001642 | OK | Practitioner - Physical Therapist in Private Practice | 1658353552 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4079 | OK | MD | Physical Therapist |
| 4574 | OK | MD | Physical Therapist |
| 1152378 | TX | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Aldridge & Dust Enterprises Inc. | Chiropractor | Current |
Accepting new patients |
Locations
12806 E 101st Pl N
Owasso, OK 74055
Phone (918) 376-4243
1401 S Utica Ave
Tulsa, OK 74104
Phone (918) 744-8200
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 11018 | TX | |
| Physical Therapist | 225100000X | 1152378 | TX | |
| Physical Therapist |
225100000X | 4574 | OK | Yes |
Addresses
Primary practice location
Elite Performance & Rehabilitation
12806 E. 101St Place N.
Owasso, OK 74055
Mailing address
12806 E 101St PL N
Owasso, OK 74055-4662
Phone (918) 376-4243
Other practice location 1
1401 S Utica Ave
Tulsa, OK 74104-4665
Phone (918) 376-4243
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4079 | Other | OK | OK CHIROPRACTIC BOARD OF EXAMINERS |
| 4574 | Other | OK | OK MEDICAL BOARD |
Other providers in Owasso, OK
- Stephen Kovacs
- Morgan Kramer
- Noah Krohner
- Taylore Dawn Kusel
- Nathan Eric Kuykendall
- Alyssa Lacey
- Lakecrest Dental-Owasso 96TH
- Ruchira Lalwani
- Kendall Lamb
- Wanjiru Landers
All providers in Owasso, OK · Physical Therapist in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 25, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.