Provider Demographics
NPI:1033733654
Name:HOLSWORTH, DIANE LYNNE (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:LYNNE
Last Name:HOLSWORTH
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5730 N 1ST ST # 105-528
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-6200
Mailing Address - Country:US
Mailing Address - Phone:559-270-1515
Mailing Address - Fax:
Practice Address - Street 1:2193 ALAMOS AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-4134
Practice Address - Country:US
Practice Address - Phone:559-385-7145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACAPT10033225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist