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General NPI Number Information
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NPI Number | 1497147839
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Entity Type | Individual
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Provider Name | NICHOLAS HOLTGRIEVE ATC
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Gender | Male
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Dates
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Enumeration Date | 02/23/2015
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Last Update Date | 04/19/2016
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Provider Practice Location Address
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Address Line | 1221 S. CLEARVIEW PARKWAY
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City | JEFFERSON
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State | LA
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Zip | 70121
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Country | US
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Telephone | 504-280-3306
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Fax |
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Provider Business Mailing Address
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Address Line | 15010 E 49TH ST
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City | KANSAS CITY
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State | MO
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Zip | 64136-1334
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Country | US
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Telephone | 816-838-0879
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT652
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | ATH.200496
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License Number State | LA
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