Provider Demographics
NPI:1023018512
Name:HOLMES, CORINNE MARIE (PT)
Entity Type:Individual
Prefix:MS
First Name:CORINNE
Middle Name:MARIE
Last Name:HOLMES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 W NYE LN
Mailing Address - Street 2:STE 205
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703-1575
Mailing Address - Country:US
Mailing Address - Phone:775-882-2211
Mailing Address - Fax:775-882-2212
Practice Address - Street 1:680 W NYE LN STE 205
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-1500
Practice Address - Country:US
Practice Address - Phone:775-882-2211
Practice Address - Fax:775-882-2212
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1389225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV003413040Medicaid
NV003413040Medicaid