Provider Demographics
NPI:1821322827
Name:HOLDMAN, CHONTELL DENISE (PT)
Entity Type:Individual
Prefix:
First Name:CHONTELL
Middle Name:DENISE
Last Name:HOLDMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 N WEST SHORE BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-1137
Mailing Address - Country:US
Mailing Address - Phone:813-261-2333
Mailing Address - Fax:
Practice Address - Street 1:2801 HIGHWAY 180 E
Practice Address - Street 2:
Practice Address - City:MINERAL WELLS
Practice Address - State:TX
Practice Address - Zip Code:76067-4730
Practice Address - Country:US
Practice Address - Phone:817-569-5700
Practice Address - Fax:773-233-9607
Is Sole Proprietor?:No
Enumeration Date:2009-09-23
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1235452225100000X
IL070017431225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist