Provider Demographics
NPI:1093799421
Name:HOLM, JENETTE K (DPT)
Entity Type:Individual
Prefix:MS
First Name:JENETTE
Middle Name:K
Last Name:HOLM
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 DIAMOND SPRINGS RD STE 103
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-6601
Mailing Address - Country:US
Mailing Address - Phone:757-395-1975
Mailing Address - Fax:757-425-7180
Practice Address - Street 1:928 DIAMOND SPRINGS RD STE 103
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-6601
Practice Address - Country:US
Practice Address - Phone:757-395-1975
Practice Address - Fax:757-425-7180
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204366225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC05954OtherGROUP MEDICARE PTAN
VA184149OtherANTHEM-BCBS