Provider Demographics
NPI:1891128260
Name:HOLT THERAPY AND WELLNESS, PLLC
Entity Type:Organization
Organization Name:HOLT THERAPY AND WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:HOLT
Authorized Official - Suffix:
Authorized Official - Credentials:M S
Authorized Official - Phone:870-732-2828
Mailing Address - Street 1:310 MID CONTINENT PLZ STE 185
Mailing Address - Street 2:
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301-1700
Mailing Address - Country:US
Mailing Address - Phone:870-732-2828
Mailing Address - Fax:870-732-1727
Practice Address - Street 1:310 MID CONTINENT PLZ STE 185
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-1700
Practice Address - Country:US
Practice Address - Phone:870-732-2828
Practice Address - Fax:870-732-1727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-20
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT1846261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1891128260OtherMEDI-PAK
AR1891128260OtherHEALTH ADVANTAGE
AR1891128260OtherBLUE CROSS BLUE SHIELD
AR1891128260OtherUSABLE