Provider Demographics
NPI:1396192381
Name:HOLMES, KARA
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:HOLMES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 WESTBERRY CT
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-2063
Mailing Address - Country:US
Mailing Address - Phone:309-550-4275
Mailing Address - Fax:
Practice Address - Street 1:3625 UTICA RIDGE RD STE B
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-1653
Practice Address - Country:US
Practice Address - Phone:563-359-6750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-19
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
IA078183225200000X
IL160.006904225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health