Provider Demographics
NPI:1447219787
Name:HOUGHTON, LORRA R (PTA)
Entity Type:Individual
Prefix:
First Name:LORRA
Middle Name:R
Last Name:HOUGHTON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:LORRA
Other - Middle Name:
Other - Last Name:REEVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:6767 S YALE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3302
Mailing Address - Country:US
Mailing Address - Phone:918-494-3000
Mailing Address - Fax:918-494-0003
Practice Address - Street 1:6767 S YALE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-3302
Practice Address - Country:US
Practice Address - Phone:918-494-3000
Practice Address - Fax:918-494-0003
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPTA943225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOKB-5862Medicare PIN