Provider Demographics
NPI:1316209836
Name:HOLMES, PHILLIP M (DPT)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:M
Last Name:HOLMES
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:P
Other - Last Name:HOLMES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:4001 INDIAN CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66207-4030
Mailing Address - Country:US
Mailing Address - Phone:913-385-0075
Mailing Address - Fax:913-385-0076
Practice Address - Street 1:4001 INDIAN CREEK PKWY
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66207-4030
Practice Address - Country:US
Practice Address - Phone:913-385-0075
Practice Address - Fax:913-385-0076
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-045482251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic