Provider Demographics
NPI:1134326036
Name:HOLMEN, CARLA JEAN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:JEAN
Last Name:HOLMEN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:643 PRINCESS PL
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75704-6668
Mailing Address - Country:US
Mailing Address - Phone:903-521-7561
Mailing Address - Fax:
Practice Address - Street 1:113 DEWS DR
Practice Address - Street 2:
Practice Address - City:WHITEHOUSE
Practice Address - State:TX
Practice Address - Zip Code:75791-5000
Practice Address - Country:US
Practice Address - Phone:903-521-7561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2018305225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant