Provider Demographics
NPI:1326304163
Name:HOLM, TODD L (LMT)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:L
Last Name:HOLM
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 N MOON AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-4418
Mailing Address - Country:US
Mailing Address - Phone:813-681-7868
Mailing Address - Fax:813-681-5698
Practice Address - Street 1:131 N MOON AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-4418
Practice Address - Country:US
Practice Address - Phone:813-681-7868
Practice Address - Fax:813-681-5698
Is Sole Proprietor?:No
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL007707225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist