MEDICARE: MR. DOUGLAS JOSEPH HOLCZER PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	12485	NC

General Provider Information

NPI Number	:	1003892365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DOUGLAS JOSEPH HOLCZER PT

Provider Business Mailing Address
First Line	:	120 WILLIAM PENN PLZ
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27704-2150
Country	:	US
Telephone Number	:	919-220-5255
Fax Number	:	919-313-1276

Provider Business Practice Location Address
First Line	:	3100 DURALEIGH RD
Second Line	:	SUITE 100
City	:	RALEIGH
State	:	NC
Zip	:	27612-8106
Country	:	US
Telephone Number	:	919-788-8797
Fax Number	:	919-313-1276

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2005
Last Update Date	:	09/23/2014

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