Provider Demographics
NPI:1235125451
Name:HOLM, ALLEN L (PT)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:L
Last Name:HOLM
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 S CLIFF AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-2129
Mailing Address - Country:US
Mailing Address - Phone:605-334-5630
Mailing Address - Fax:605-332-5327
Practice Address - Street 1:1720 S CLIFF AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-2129
Practice Address - Country:US
Practice Address - Phone:605-334-5630
Practice Address - Fax:605-332-5327
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0215225100000X
MN6177225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0215OtherDAKOTACARE
SD5831602Medicaid
SD4998212OtherBLUE CROSS BLUE SHIELD SD
SD64-04050OtherMEDICA
SD4998554OtherBLUE CROSS BLUE SHIELD SD
SD64-05331OtherMEDICA
SD20704OtherSIOUX VALLEY HEALTH PLANS
SD5831606Medicaid
SD10F99HOOtherBLUE CROSS BLUE SHIELD MN
SD64-07563OtherMEDICA
SD793621OtherARAZ
MNO3S71HOOtherBLUE CROSS BLUE SHIELD MN
SD4994835OtherBLUE CROSS BLUE SHIELD SD
SD64-07183OtherMEDICA