Provider Demographics
NPI:1144613167
Name:NIEMAN, HOLLY (MS,LAT, ATC, EMT)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:NIEMAN
Suffix:
Gender:F
Credentials:MS,LAT, ATC, EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4933 WHEELER DR
Mailing Address - Street 2:
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-1031
Mailing Address - Country:US
Mailing Address - Phone:231-534-4551
Mailing Address - Fax:
Practice Address - Street 1:4933 WHEELER DR
Practice Address - Street 2:
Practice Address - City:THE COLONY
Practice Address - State:TX
Practice Address - Zip Code:75056-1031
Practice Address - Country:US
Practice Address - Phone:231-534-4551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-16
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT77732255A2300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer