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NPI Code Detail

MEDICARE: NATHANIEL HOLMES PT, DPT

MEDICARE: NATHANIEL HOLMES PT, DPT
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 Therapist070020824IL

General Provider Information

NPI Number : 1184024325
Entity Type Code : Individual
Provider Name (Legal Business Name) : NATHANIEL HOLMES PT, DPT
Provider Business Mailing Address
First Line : 1502 PARKVIEW AVE
Second Line :
City : ROCKFORD
State : IL
Zip : 61107-1821
Country : US
Telephone Number : 815-381-7284
Fax Number : 815-381-7281
Provider Business Practice Location Address
First Line : 1502 PARKVIEW AVE
Second Line :
City : ROCKFORD
State : IL
Zip : 61107-1821
Country : US
Telephone Number : 815-381-7284
Fax Number : 815-381-7281
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2014
Last Update Date : 03/27/2017

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