Individual
HOLLY GOFORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8652 S PEORIA AVE, TULSA, OK 74132-2827
(915) 409-0157
Mailing address
425 N ROSS ST, SAPULPA, OK 74066-3659
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2528
OK
Other
Enumeration date
09/02/2021
Last updated
09/02/2021
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