Provider Demographics
NPI:1932457330
Name:THOMAS, HOLLY MICHELE (PT)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:MICHELE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:
Other - Last Name:WILES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3903 NORTHDALE BLVD
Mailing Address - Street 2:SUITE 111W
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-1864
Mailing Address - Country:US
Mailing Address - Phone:813-381-6778
Mailing Address - Fax:440-815-2120
Practice Address - Street 1:3903 NORTHDALE BLVD
Practice Address - Street 2:SUITE 111W
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-1864
Practice Address - Country:US
Practice Address - Phone:813-381-6778
Practice Address - Fax:440-815-2120
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-04437225100000X
MO2012015111225100000X
OK4421225100000X
FLPT29680225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist