Provider Demographics
NPI:1790026664
Name:HOLZMAN, MARY S (PTA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:S
Last Name:HOLZMAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 PAANAU RD
Mailing Address - Street 2:APT O203
Mailing Address - City:KOLOA
Mailing Address - State:HI
Mailing Address - Zip Code:96756-9430
Mailing Address - Country:US
Mailing Address - Phone:808-639-8544
Mailing Address - Fax:
Practice Address - Street 1:2-2514 KAUMUALII HWY
Practice Address - Street 2:SUITE 205
Practice Address - City:KALAHEO
Practice Address - State:HI
Practice Address - Zip Code:96741-8303
Practice Address - Country:US
Practice Address - Phone:808-333-3688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-01
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1349225200000X
HI6392225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist