Provider Demographics
NPI:1659704120
Name:HOLT, KEVIN DEAN (MS PT)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:DEAN
Last Name:HOLT
Suffix:
Gender:M
Credentials:MS PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1002 GEORGETOWN CV
Mailing Address - Street 2:
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301-3863
Mailing Address - Country:US
Mailing Address - Phone:870-732-8710
Mailing Address - Fax:
Practice Address - Street 1:310 MID CONTINENT PLZ STE 185
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-1700
Practice Address - Country:US
Practice Address - Phone:870-732-2828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-19
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT1846225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist