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General NPI Number Information
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NPI Number | 1265978167
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Entity Type | Individual
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Provider Name | NICHOLAS HOLMAN DPT
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Gender | Male
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Dates
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Enumeration Date | 01/16/2017
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Last Update Date | 01/16/2017
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Provider Practice Location Address
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Address Line | 2502 FAYETTEVILLE RD
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City | VAN BUREN
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State | AR
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Zip | 72956-6073
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Country | US
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Telephone | 479-430-9310
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 584
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City | ALMA
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State | AR
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Zip | 72921-0584
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Country | US
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Telephone | 479-430-9310
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT 3566
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License Number State | AR
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