Provider Demographics
NPI:1326485681
Name:HOLMES, BETH (PT)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:HOLMES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9800 CAYGOUDE CT
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-8191
Mailing Address - Country:US
Mailing Address - Phone:909-851-2260
Mailing Address - Fax:
Practice Address - Street 1:5050 AVENIDA ENCINAS
Practice Address - Street 2:SUITE 250
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-4381
Practice Address - Country:US
Practice Address - Phone:760-729-5433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15645225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist