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General NPI Number Information
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NPI Number | 1104942226
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Entity Type | Individual
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Provider Name | BETH A HOLDRIDGE PTA
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Gender | Female
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 245 S 22ND ST
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City | BLAIR
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State | NE
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Zip | 68008-1811
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Country | US
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Telephone | 402-424-2177
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Fax |
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Provider Business Mailing Address
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Address Line | 451 SOUTH 16TH STREET #106
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City | BLAIR
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State | NE
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Zip | 68008-1815
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Country | US
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Telephone | 402-429-3521
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 504
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License Number State | NE
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