Provider Demographics
NPI:1407927163
Name:HOLMGREN, HELEN-MARIE (PT)
Entity Type:Individual
Prefix:
First Name:HELEN-MARIE
Middle Name:
Last Name:HOLMGREN
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:PO BOX 23375
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86002-3375
Mailing Address - Country:US
Mailing Address - Phone:928-779-0673
Mailing Address - Fax:928-779-0673
Practice Address - Street 1:380 E HUTCHESON DR
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-3270
Practice Address - Country:US
Practice Address - Phone:928-779-0673
Practice Address - Fax:928-779-0673
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1224225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0295140OtherBLUE CROSS BLUE SHIELD