Provider Demographics
NPI:1790101376
Name:REEVES, HOLLY JEAN (PTA)
Entity Type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:JEAN
Last Name:REEVES
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 1:2320 E MACARTHUR RD LOT A23
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67216-2665
Mailing Address - Country:US
Mailing Address - Phone:316-305-2874
Mailing Address - Fax:
Practice Address - Street 1:777 N MCLEAN BLVD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-4980
Practice Address - Country:US
Practice Address - Phone:877-498-6452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-06
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-02443225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant