Individual
MRS. ANGELA ELAINE HOLDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T. PHYSICAL THERAP
Contact information
Practice address
1618 NE 31ST ST, LAWTON, OK 73507-3432
(405) 747-4358
Mailing address
BOX 54, GOULD, OK 73544
(405) 747-4358
(580) 676-3951
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2529
OK
2251P0200X
Pediatric Physical Therapist
2529
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200038480A
—
OK
05
—
200038480B
—
OK
Enumeration date
10/03/2006
Last updated
07/22/2020
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