Provider Demographics
NPI:1508806829
Name:HOLMES, RETT LANDIN (MSPT)
Entity Type:Individual
Prefix:
First Name:RETT
Middle Name:LANDIN
Last Name:HOLMES
Suffix:
Gender:M
Credentials:MSPT
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 3340
Mailing Address - Street 2:NEW VALLEY REHAB
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18043-3340
Mailing Address - Country:US
Mailing Address - Phone:484-851-3386
Mailing Address - Fax:484-851-3469
Practice Address - Street 1:3213 NAZARETH RD
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-2000
Practice Address - Country:US
Practice Address - Phone:610-438-8093
Practice Address - Fax:610-438-8095
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT016867225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50037203OtherCAPITAL
PAH01605507OtherHIGHMARK