Provider Demographics
NPI:1710957956
Name:HOLDER, TIMOTHY J (MPT)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:J
Last Name:HOLDER
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4685 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-3397
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:513-852-8525
Practice Address - Street 1:6909 GOOD SAMARITAN DR STE A
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45247-5209
Practice Address - Country:US
Practice Address - Phone:513-246-7846
Practice Address - Fax:513-245-5424
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT.008149225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0108341Medicaid
OH000000190966OtherBCBS
OH0108341Medicaid