Healthcare Provider Details

I. General information

NPI: 1780309336
Provider Name (Legal Business Name): COLBY JO HOLCOMB PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COLBY JO SAWYER

II. Dates (important events)

Enumeration Date: 10/06/2022
Last Update Date: 09/11/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1188 N HILLS SHOPPING CTR
ADA OK
74820-1864
US

IV. Provider business mailing address

440 MERCHANT DR
NORMAN OK
73069-6470
US

V. Phone/Fax

Practice location:
  • Phone: 580-453-4455
  • Fax:
Mailing address:
  • Phone: 405-809-8713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number3601
License Number StateOK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: