Provider Demographics
NPI:1033370168
Name:HOLGADO, EMMANUEL (PTA)
Entity Type:Individual
Prefix:MR
First Name:EMMANUEL
Middle Name:
Last Name:HOLGADO
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 700973
Mailing Address - Street 2:
Mailing Address - City:WABASSO
Mailing Address - State:FL
Mailing Address - Zip Code:32970-0973
Mailing Address - Country:US
Mailing Address - Phone:772-589-5992
Mailing Address - Fax:
Practice Address - Street 1:8825 104TH CT
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32967-3266
Practice Address - Country:US
Practice Address - Phone:201-965-8344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA20204225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant