Provider Demographics
NPI:1134108889
Name:HOLTE, JAMES BURKE (PT OCS CSCS, FAAOMPT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:BURKE
Last Name:HOLTE
Suffix:
Gender:M
Credentials:PT OCS CSCS, FAAOMPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:2431 CORAL CT
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-2838
Mailing Address - Country:US
Mailing Address - Phone:319-545-4104
Mailing Address - Fax:319-545-4105
Practice Address - Street 1:2431 CORAL CT
Practice Address - Street 2:SUITE 2
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-2838
Practice Address - Country:US
Practice Address - Phone:319-545-4104
Practice Address - Fax:319-545-4105
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA01276225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0160804Medicaid
IAI8408Medicare PIN