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General NPI Number Information
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NPI Number | 1093639379
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Entity Type | Individual
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Provider Name | REAGAN ELIZABETH HOLT PTA
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Gender | Female
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Dates
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Enumeration Date | 08/07/2026
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Last Update Date | 08/07/2026
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Provider Practice Location Address
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Address Line | 3345 S HARVARD AVE # 101301
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City | TULSA
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State | OK
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Zip | 74135-1812
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Country | US
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Telephone | 918-574-2575
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Fax |
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Provider Business Mailing Address
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Address Line | 21161 E 112TH ST S
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City | BROKEN ARROW
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State | OK
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Zip | 74014-6218
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 4232
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License Number State | OK
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