Provider Demographics
NPI:1497367247
Name:LIEURANCE, HOLLY (DPT)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:LIEURANCE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 TAMA ST SE STE 700
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-4558
Mailing Address - Country:US
Mailing Address - Phone:319-447-0700
Mailing Address - Fax:
Practice Address - Street 1:120 TWIN STEEPLES CIR NE
Practice Address - Street 2:
Practice Address - City:DYERSVILLE
Practice Address - State:IA
Practice Address - Zip Code:52040-1255
Practice Address - Country:US
Practice Address - Phone:563-855-8600
Practice Address - Fax:563-855-8601
Is Sole Proprietor?:No
Enumeration Date:2020-08-21
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA100679225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist