Healthcare Provider Details

I. General information

NPI: 1417931320
Provider Name (Legal Business Name): SCOTT LAWRENCE HOLMAN PT DPT OCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 12/18/2023
Certification Date: 12/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 RIVERWALK BLVD STE 2F
RIDGELAND SC
29936-5071
US

IV. Provider business mailing address

66 DAFFODIL FARM RD
BLUFFTON SC
29910-5349
US

V. Phone/Fax

Practice location:
  • Phone: 951-375-7102
  • Fax:
Mailing address:
  • Phone: 951-375-7102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3869
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number3869
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: