Provider Demographics
NPI:1376840694
Name:GRABER, HOLLY A (PTA)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:A
Last Name:GRABER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:A
Other - Last Name:LITTLEPAGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:677 ANNE ST NW
Mailing Address - Street 2:SUITE E
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-4390
Mailing Address - Country:US
Mailing Address - Phone:218-444-8280
Mailing Address - Fax:218-444-8337
Practice Address - Street 1:677 ANNE ST NW
Practice Address - Street 2:SUITE E
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-4390
Practice Address - Country:US
Practice Address - Phone:218-444-8280
Practice Address - Fax:218-444-8337
Is Sole Proprietor?:No
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA1442225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant