MEDICARE: ASHLEY HOLDER

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	2122687	TX

General Provider Information

NPI Number	:	1275087520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY HOLDER

Provider Business Mailing Address
First Line	:	8404B CIMA OAK LN
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-8260
Country	:	US
Telephone Number	:	512-496-7137
Fax Number	:

Provider Business Practice Location Address
First Line	:	8404B CIMA OAK LN
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-8260
Country	:	US
Telephone Number	:	512-496-7137
Fax Number	:

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

Provider Enumeration Date	:	08/03/2016
Last Update Date	:	08/03/2016

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Directions to “ ASHLEY HOLDER ” Practice Location

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