MEDICARE: MATTHEW HOLMAN PTA

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
1	225200000X	Physical Therapy Assistant	P1 60233476	WA
2	225200000X	Physical Therapy Assistant

General Provider Information

NPI Number	:	1073973632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW HOLMAN PTA

Provider Business Mailing Address
First Line	:	171 SW 6TH AVE
Second Line	:
City	:	OAK HARBOR
State	:	WA
Zip	:	98277-2377
Country	:	US
Telephone Number	:	253-228-2285
Fax Number	:	360-679-0919

Provider Business Practice Location Address
First Line	:	171 SW 6TH AVE
Second Line	:
City	:	OAK HARBOR
State	:	WA
Zip	:	98277-2377
Country	:	US
Telephone Number	:	360-279-2555
Fax Number	:	360-679-0919

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2016
Last Update Date	:	04/23/2024

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