Provider Demographics
NPI:1467643379
Name:HOLMAN, LIA K (MPT)
Entity Type:Individual
Prefix:MS
First Name:LIA
Middle Name:K
Last Name:HOLMAN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 FOREST CREEK DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27107-9225
Mailing Address - Country:US
Mailing Address - Phone:336-769-0326
Mailing Address - Fax:336-769-0326
Practice Address - Street 1:136 FOREST CREEK DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27107-9225
Practice Address - Country:US
Practice Address - Phone:336-769-0326
Practice Address - Fax:336-769-0326
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7876225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist