Healthcare Provider Details

I. General information

NPI: 1265498232
Provider Name (Legal Business Name): JAMES M. HOLT A.T.C.,
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOSPITAL AVE
DU BOIS PA
15801-1440
US

IV. Provider business mailing address

1319 E PRESQUEISLE ST
PHILIPSBURG PA
16866-1227
US

V. Phone/Fax

Practice location:
  • Phone: 814-375-3372
  • Fax: 814-375-3049
Mailing address:
  • Phone: 814-342-0403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT000730A
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: