Provider Demographics
NPI:1225255789
Name:HOLDER, IJUNANYA (DPT)
Entity Type:Individual
Prefix:DR
First Name:IJUNANYA
Middle Name:
Last Name:HOLDER
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 1:2 SHERMAN POTTS DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:GHENT
Mailing Address - State:NY
Mailing Address - Zip Code:12075-3216
Mailing Address - Country:US
Mailing Address - Phone:518-965-6099
Mailing Address - Fax:
Practice Address - Street 1:2 SHERMAN POTTS DR
Practice Address - Street 2:SUITE 202
Practice Address - City:GHENT
Practice Address - State:NY
Practice Address - Zip Code:12075-3216
Practice Address - Country:US
Practice Address - Phone:518-965-6099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028416225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist