Provider Demographics
NPI:1982835773
Name:HOLLAND-VINCENT, TRACI (PT)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:
Last Name:HOLLAND-VINCENT
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 1:5225 CANYON CREST DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-6301
Mailing Address - Country:US
Mailing Address - Phone:951-683-3309
Mailing Address - Fax:951-683-1886
Practice Address - Street 1:5225 CANYON CREST DR
Practice Address - Street 2:SUITE 205
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-6301
Practice Address - Country:US
Practice Address - Phone:951-683-3309
Practice Address - Fax:951-683-1886
Is Sole Proprietor?:No
Enumeration Date:2009-07-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT15473225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist