Provider Demographics
NPI:1831924620
Name:ENBERG, THOMAS BARTLEY I
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:BARTLEY
Last Name:ENBERG
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25345 E 87TH PL S
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74014-6192
Mailing Address - Country:US
Mailing Address - Phone:469-766-8468
Mailing Address - Fax:
Practice Address - Street 1:101 E 81ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74132-2818
Practice Address - Country:US
Practice Address - Phone:469-766-8468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer