Provider Demographics
NPI:1700334174
Name:HOLLEY, JOHN W
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:HOLLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 NW 132ND
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142-4430
Mailing Address - Country:US
Mailing Address - Phone:405-843-5710
Mailing Address - Fax:405-843-5720
Practice Address - Street 1:5700 NW 132ND
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142-4430
Practice Address - Country:US
Practice Address - Phone:405-843-5710
Practice Address - Fax:405-843-5720
Is Sole Proprietor?:No
Enumeration Date:2016-09-14
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5197225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist