Provider Demographics
NPI:1184403297
Name:HOLTMAN, DANAE (PT)
Entity type:Individual
Prefix:DR
First Name:DANAE
Middle Name:
Last Name:HOLTMAN
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 1:37105 BENEDICT ST
Mailing Address - Street 2:
Mailing Address - City:CONCEPTION
Mailing Address - State:MO
Mailing Address - Zip Code:64433-8113
Mailing Address - Country:US
Mailing Address - Phone:660-254-2255
Mailing Address - Fax:
Practice Address - Street 1:409 W SOUTH HILLS DR
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:MO
Practice Address - Zip Code:64468-3639
Practice Address - Country:US
Practice Address - Phone:660-562-7908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022022951225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist