MEDICARE: BRIDGET ANN HOLDAR MS 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	1339	NV

General Provider Information

NPI Number	:	1730121419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIDGET ANN HOLDAR MS PT

Provider Business Mailing Address
First Line	:	436 WOODRIDGE DR
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89015-6041
Country	:	US
Telephone Number	:	702-568-7184
Fax Number	:

Provider Business Practice Location Address
First Line	:	4765 S DURANGO DR
Second Line	:	SUITE #106
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-8145
Country	:	US
Telephone Number	:	702-898-7633
Fax Number	:

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

Provider Enumeration Date	:	06/10/2006
Last Update Date	:	07/08/2007

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