Provider Demographics
NPI:1508054099
Name:LASHLEY, HOLLY B (PT)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:B
Last Name:LASHLEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:421 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-6450
Mailing Address - Country:US
Mailing Address - Phone:918-494-2902
Mailing Address - Fax:918-301-0055
Practice Address - Street 1:5711 E 71ST ST STE 220
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-6655
Practice Address - Country:US
Practice Address - Phone:918-494-2902
Practice Address - Fax:918-494-2905
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2019-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4061225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK4061OtherLICENSE