Healthcare Provider Details

I. General information

NPI: 1083679815
Provider Name (Legal Business Name): ERIN H. HOLMES P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 10/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 S MAIN AVE
LAKE PLACID FL
33852-1808
US

IV. Provider business mailing address

104 S MAIN AVE
LAKE PLACID FL
33852-1808
US

V. Phone/Fax

Practice location:
  • Phone: 863-699-6929
  • Fax:
Mailing address:
  • Phone: 863-699-6929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberPT19801
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: