Provider Demographics
NPI:1417931320
Name:HOLMAN, SCOTT LAWRENCE (PT DPT OCS)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:LAWRENCE
Last Name:HOLMAN
Suffix:
Gender:M
Credentials:PT DPT OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 DAFFODIL FARM RD
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-5349
Mailing Address - Country:US
Mailing Address - Phone:951-375-7102
Mailing Address - Fax:
Practice Address - Street 1:61 RIVERWALK BLVD STE 2F
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:SC
Practice Address - Zip Code:29936-5071
Practice Address - Country:US
Practice Address - Phone:951-375-7102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC38692251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA156489Medicare PIN
CACA156488Medicare PIN
CACA156490Medicare PIN
CACB235476Medicare PIN
CACA156488Medicare PIN
CACA156490Medicare PIN
CACB235476Medicare PIN