Provider Demographics
NPI:1174005045
Name:HUSO, HOLLY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:HUSO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:
Other - Last Name:KRAMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1284 CORPORATE CENTER DR STE 500
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-1280
Mailing Address - Country:US
Mailing Address - Phone:612-863-6029
Mailing Address - Fax:612-863-8942
Practice Address - Street 1:1284 CORPORATE CENTER DR STE 500
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-1280
Practice Address - Country:US
Practice Address - Phone:612-863-6029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-06
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14771225100000X
MN11277225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN11277OtherLICENSE