Provider Demographics
NPI:1679703409
Name:BURT, HOLLY CAMERON (DPT)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:CAMERON
Last Name:BURT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:
Other - Last Name:DURNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:720 WEST JONES STREET
Mailing Address - Street 2:SUITE 110
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603
Mailing Address - Country:US
Mailing Address - Phone:919-258-2714
Mailing Address - Fax:
Practice Address - Street 1:720 WEST JONES STREET
Practice Address - Street 2:SUITE 110
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603
Practice Address - Country:US
Practice Address - Phone:919-443-0723
Practice Address - Fax:919-322-0041
Is Sole Proprietor?:No
Enumeration Date:2009-07-14
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23980225100000X
VA23052060222251X0800X
NCP15321225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic