Healthcare Provider Details

I. General information

NPI: 1649642463
Provider Name (Legal Business Name): SHANNA HOLTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2015
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15550 FRANK LLOYD WRIGHT BLVD 1015
SCOTTSDALE AZ
85260
US

IV. Provider business mailing address

15550 FRANK LLOYD WRIGHT BLVD 1015
SCOTTSDALE AZ
85260
US

V. Phone/Fax

Practice location:
  • Phone: 480-788-4839
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number014302
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License NumberMASTER'S DEGREE
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: