MEDICARE: TIMOTHY J. HOLDER MPT

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	PT.008149	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000190966	OTHER	OH	BCBS

General Provider Information

NPI Number	:	1710957956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY J. HOLDER MPT

Provider Business Mailing Address
First Line	:	4685 FOREST AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45212-3397
Country	:	US
Telephone Number	:
Fax Number	:	513-852-8525

Provider Business Practice Location Address
First Line	:	6909 GOOD SAMARITAN DR STE A
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45247-5209
Country	:	US
Telephone Number	:	513-246-7846
Fax Number	:	513-245-5424

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

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	03/05/2019

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