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NPI Code Detail

MEDICARE: MS. JENETTE K HOLM DPT

MEDICARE:  MS. JENETTE K HOLM  DPT
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
1225100000XPhysical Therapist2305204366VA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1C05954OTHERVAGROUP MEDICARE PTAN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2184149OTHERVAANTHEM-BCBS

General Provider Information

NPI Number : 1093799421
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JENETTE K HOLM DPT
Provider Business Mailing Address
First Line : 928 DIAMOND SPRINGS RD STE 103
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23455-6601
Country : US
Telephone Number : 757-395-1975
Fax Number : 757-425-7180
Provider Business Practice Location Address
First Line : 928 DIAMOND SPRINGS RD STE 103
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23455-6601
Country : US
Telephone Number : 757-395-1975
Fax Number : 757-425-7180
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/30/2005
Last Update Date : 04/22/2022

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Directions to “ MS. JENETTE K HOLM DPT” Practice Location

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