Provider Demographics
NPI:1003253204
Name:ERIN HOLM PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:ERIN HOLM PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:HOLM
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:406-461-7073
Mailing Address - Street 1:909 IDLEWILDE CT
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-0430
Mailing Address - Country:US
Mailing Address - Phone:406-461-7073
Mailing Address - Fax:877-795-8113
Practice Address - Street 1:909 IDLEWILDE CT
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-0430
Practice Address - Country:US
Practice Address - Phone:406-461-7073
Practice Address - Fax:877-795-8113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1965PT261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT3402048Medicaid
MT000050849Medicare PIN