Provider Demographics
NPI:1871162560
Name:WRIGHT, HOLLY (PT, DPT)
Entity type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:
Other - Last Name:HEMBREE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1103 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:TONKAWA
Mailing Address - State:OK
Mailing Address - Zip Code:74653-1519
Mailing Address - Country:US
Mailing Address - Phone:580-749-0001
Mailing Address - Fax:
Practice Address - Street 1:2211 N 14TH ST
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-1841
Practice Address - Country:US
Practice Address - Phone:580-765-0101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5991208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK5991Medicaid