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General NPI Number Information
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NPI Number | 1275413171
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Entity Type | Individual
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Provider Name | MARISSA HOLMES DPT
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Gender | Female
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Dates
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Enumeration Date | 09/03/2025
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Last Update Date | 09/03/2025
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Provider Practice Location Address
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Address Line | 924 S COMMERCIAL ST
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City | HARRISBURG
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State | IL
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Zip | 62946-2637
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Country | US
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Telephone | 618-252-7171
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Fax | 618-252-7272
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Provider Business Mailing Address
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Address Line | 1301 KARRIS LN APT B
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City | MARION
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State | IL
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Zip | 62959-3197
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Country | US
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Telephone |
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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 | 070.029484
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License Number State | IL
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