Healthcare Provider Details

I. General information

NPI: 1073430583
Provider Name (Legal Business Name): KELLY HOLMAN PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2026
Last Update Date: 07/04/2026
Certification Date: 07/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1216 WOODBROOK CT
RESTON VA
20194-1344
US

IV. Provider business mailing address

1216 WOODBROOK CT
RESTON VA
20194-1344
US

V. Phone/Fax

Practice location:
  • Phone: 757-288-6473
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: KELLY HOLMAN
Title or Position: PHYSICAL THERAPIST
Credential: PT, DPT
Phone: 757-288-6473