Provider Demographics
NPI:1023350584
Name:HOLT, JANE ELIZABETH (LMT)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:ELIZABETH
Last Name:HOLT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CANEBREAKERS DR
Mailing Address - Street 2:UNIT 209
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32927-6080
Mailing Address - Country:US
Mailing Address - Phone:321-609-0212
Mailing Address - Fax:
Practice Address - Street 1:100 CANEBREAKERS DR
Practice Address - Street 2:UNIT 209
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32927-6080
Practice Address - Country:US
Practice Address - Phone:321-609-0212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-22
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA68273225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist