Provider Demographics
NPI:1063482354
Name:HOLT, BEVERLY (PT)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:HOLT
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 1:111 FALLVIEW DR
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-4197
Mailing Address - Country:US
Mailing Address - Phone:860-633-3800
Mailing Address - Fax:
Practice Address - Street 1:2162 SILAS DEANE HWY
Practice Address - Street 2:
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-2315
Practice Address - Country:US
Practice Address - Phone:860-513-1431
Practice Address - Fax:860-529-0126
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002163225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist