Healthcare Provider Details

I. General information

NPI: 1760522551
Provider Name (Legal Business Name): JULIE HOLT DSC, MPT, CPC, ELIMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 11/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17232 RED HILL AVE
IRVINE CA
92614-5628
US

IV. Provider business mailing address

14 CORPORATE PLAZA DR STE 120
NEWPORT BEACH CA
92660-7995
US

V. Phone/Fax

Practice location:
  • Phone: 949-462-0560
  • Fax:
Mailing address:
  • Phone: 949-266-7893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT 24207
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: