MEDICARE: JENNIFER HOLT 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
1	225100000X	Physical Therapist	1347749	TX

General Provider Information

NPI Number	:	1194278473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER HOLT DPT

Provider Business Mailing Address
First Line	:	427 REGATTA LN
Second Line	:
City	:	AZLE
State	:	TX
Zip	:	76020-2948
Country	:	US
Telephone Number	:	920-471-3700
Fax Number	:

Provider Business Practice Location Address
First Line	:	9705 TEHAMA RIDGE PKWY STE 122
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76177-7522
Country	:	US
Telephone Number	:	920-471-3700
Fax Number	:

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

Provider Enumeration Date	:	08/03/2016
Last Update Date	:	04/15/2026

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