Provider Demographics
NPI:1659075356
Name:HOLDEN, GRACE ANNE (R-DMT)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:ANNE
Last Name:HOLDEN
Suffix:
Gender:F
Credentials:R-DMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2236 43RD ST APT 2
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-1489
Mailing Address - Country:US
Mailing Address - Phone:218-760-0642
Mailing Address - Fax:
Practice Address - Street 1:2236 43RD ST APT 2
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-1489
Practice Address - Country:US
Practice Address - Phone:218-760-0642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP119123225600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance Therapist