Provider Demographics
NPI:1629230180
Name:SOEHLMAN, HOLLIE A (PTA)
Entity Type:Individual
Prefix:
First Name:HOLLIE
Middle Name:A
Last Name:SOEHLMAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2104 N BROADWAY ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-2501
Mailing Address - Country:US
Mailing Address - Phone:918-649-0799
Mailing Address - Fax:918-649-0797
Practice Address - Street 1:2104 N BROADWAY ST
Practice Address - Street 2:SUITE B
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-2501
Practice Address - Country:US
Practice Address - Phone:918-649-0799
Practice Address - Fax:918-649-0797
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1219225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant