Provider Demographics
NPI:1548596760
Name:FRY, HOLLY DIANE (ATC)
Entity Type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:DIANE
Last Name:FRY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:632 N NEVADA AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-1024
Mailing Address - Country:US
Mailing Address - Phone:303-909-7881
Mailing Address - Fax:
Practice Address - Street 1:14 E CACHE LA POUDRE ST
Practice Address - Street 2:EL POMAR - ATHLETICS
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-3243
Practice Address - Country:US
Practice Address - Phone:719-389-6990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-22
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer