Provider Demographics
NPI:1578117867
Name:HOLMES, STACIE G (PROSTHESIS TRAINER)
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:G
Last Name:HOLMES
Suffix:
Gender:F
Credentials:PROSTHESIS TRAINER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 RENAISSANCE POINTE
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-3537
Mailing Address - Country:US
Mailing Address - Phone:407-844-3205
Mailing Address - Fax:
Practice Address - Street 1:801 W STATE ROAD 436 STE 2013
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-3053
Practice Address - Country:US
Practice Address - Phone:407-844-3205
Practice Address - Fax:407-917-9688
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-25
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier