Provider Demographics
NPI:1659041325
Name:HOLLIDAY, AMBREY (PT)
Entity Type:Individual
Prefix:
First Name:AMBREY
Middle Name:
Last Name:HOLLIDAY
Suffix:
Gender:F
Credentials:PT
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 591
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:TX
Mailing Address - Zip Code:75762-0591
Mailing Address - Country:US
Mailing Address - Phone:903-594-8140
Mailing Address - Fax:
Practice Address - Street 1:107 W 29TH ST STE 100
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-2200
Practice Address - Country:US
Practice Address - Phone:970-663-6142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0017820225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist