Provider Demographics
NPI:1639224991
Name:HOLDORF, DENISE MARY (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:MARY
Last Name:HOLDORF
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5920 S RANGELINE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-8970
Mailing Address - Country:US
Mailing Address - Phone:573-289-1055
Mailing Address - Fax:
Practice Address - Street 1:5920 S RANGELINE RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8970
Practice Address - Country:US
Practice Address - Phone:573-289-1055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00812174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist