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NPI Code Detail

MEDICARE: JILL T HOLDEN P.T.

MEDICARE: JILL T HOLDEN P.T.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist51010005705MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10B81114OTHERMIBCBS OF MI

General Provider Information

NPI Number : 1073726766
Entity Type Code : Individual
Provider Name (Legal Business Name) : JILL T HOLDEN P.T.
Provider Business Mailing Address
First Line : 4000 EASTERN SKY DR STE 6
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49684-7351
Country : US
Telephone Number : 231-932-9014
Fax Number : 231-932-9034
Provider Business Practice Location Address
First Line : 4000 EASTERN SKY DR STE 6
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49684-7351
Country : US
Telephone Number : 231-932-9014
Fax Number : 231-932-9034
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/08/2007
Last Update Date : 07/08/2007

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