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General NPI Number Information
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NPI Number | 1497448187
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Entity Type | Individual
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Provider Name | JACOB HOLT PT, DPT, AT, ATC
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Gender | Male
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Dates
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Enumeration Date | 05/30/2023
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Last Update Date | 04/28/2025
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Provider Practice Location Address
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Address Line | 1232 GRISWOLD ST SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49507-3815
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Country | US
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Telephone | 616-207-3861
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Fax |
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Provider Business Mailing Address
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Address Line | 1002 W BROOMFIELD ST APT 8C
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City | MOUNT PLEASANT
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State | MI
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Zip | 48858-4530
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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 | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 5501302468
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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