Brook Colburn Detrick, LMT, CMLDT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

157786 Issued in OK

Practice address

1501 N Florence Ave
Claremore, OK 74017-3179

Phone

(918) 706-1302

NPI assigned

Sep 16, 2022

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Theology

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• RBS Evolution of Oklahoma LLC

  • Radiation Oncology Physician
  • Claremore, OK
  • NPI 1366958829
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1663286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663286400000",
    "number": "1760104525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "417 SCRAPER ST",
            "city": "CATOOSA",
            "state": "OK",
            "postal_code": "740152509",
            "telephone_number": "918-706-1302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 N FLORENCE AVE",
            "city": "CLAREMORE",
            "state": "OK",
            "postal_code": "740173179",
            "telephone_number": "918-706-1302"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1875 N Highway 66 Ste A",
            "address_purpose": "LOCATION",
            "city": "Catoosa",
            "state": "OK",
            "postal_code": "740153072",
            "country_code": "US",
            "telephone_number": "918-706-1302",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DETRICK",
        "first_name": "BROOK",
        "middle_name": "COLBURN",
        "credential": "LMT, CMLDT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-09-16",
        "last_updated": "2022-09-16",
        "certification_date": "2022-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "OK",
            "license": "157786",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mandy Deiser-Thueson
• Delo Brothers
• Alexander James Demand, DO
• Jessica Depoe
• Seth Palmer Destefano
• Elizabeth Devary, LPC
• Leah Michelle Dewhitt
• DHHS US Public Health Service Indian Health Service
• Linsey Dickerson
• Jennifer Deleen Dill

• All providers in Claremore, OK
• Massage Therapist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.