Healthcare Provider Details

I. General information

NPI: 1093639379
Provider Name (Legal Business Name): REAGAN ELIZABETH HOLT PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3345 S HARVARD AVE # 101301
TULSA OK
74135-1812
US

IV. Provider business mailing address

21161 E 112TH ST S
BROKEN ARROW OK
74014-6218
US

V. Phone/Fax

Practice location:
  • Phone: 918-574-2575
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number4232
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: