Provider Demographics
NPI:1730121419
Name:HOLDAR, BRIDGET ANN (MS PT)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:ANN
Last Name:HOLDAR
Suffix:
Gender:F
Credentials:MS PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 WOODRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-6041
Mailing Address - Country:US
Mailing Address - Phone:702-568-7184
Mailing Address - Fax:
Practice Address - Street 1:4765 S DURANGO DR
Practice Address - Street 2:SUITE #106
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-8145
Practice Address - Country:US
Practice Address - Phone:702-898-7633
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1339225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1021166Medicare ID - Type Unspecified