Healthcare Provider Details

I. General information

NPI: 1124067400
Provider Name (Legal Business Name): ALICE DORWORTH HOLDER PT, MHS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 VINE ST CINCINNATI VAMC MDP 117
CINCINNATI OH
45220-2213
US

IV. Provider business mailing address

8471 SHUMAN LN
CINCINNATI OH
45231-5736
US

V. Phone/Fax

Practice location:
  • Phone: 513-861-3100
  • Fax: 513-487-6624
Mailing address:
  • Phone: 513-931-0011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License NumberPT007191
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: