Provider Demographics
NPI:1659617876
Name:THOMPSON, HOLLY SHANNON (PT)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:SHANNON
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3007 S BOSTON CT
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-5216
Mailing Address - Country:US
Mailing Address - Phone:918-293-0631
Mailing Address - Fax:918-293-0631
Practice Address - Street 1:3345 S HARVARD AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-1812
Practice Address - Country:US
Practice Address - Phone:918-743-3737
Practice Address - Fax:918-743-8833
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-14
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2788225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist