Healthcare Provider Details

I. General information

NPI: 1932015443
Provider Name (Legal Business Name): KRISTEN JANAE HOLMES PT, DPT, CLT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1282 UNION AVE
MEMPHIS TN
38104-3414
US

IV. Provider business mailing address

918 BAYOU VISTA DR
MARION AR
72364-5076
US

V. Phone/Fax

Practice location:
  • Phone: 901-729-5175
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12086
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: