Provider Demographics
NPI:1245274158
Name:HOLMAN, VIRGINIA SUSAN (MPT)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:SUSAN
Last Name:HOLMAN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:GINGER
Other - Middle Name:SUSAN
Other - Last Name:HOLMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:495 STATE ST FL 6
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3757
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1359 N PACIFIC HWY
Practice Address - Street 2:
Practice Address - City:WOODBURN
Practice Address - State:OR
Practice Address - Zip Code:97071
Practice Address - Country:US
Practice Address - Phone:503-982-0232
Practice Address - Fax:503-873-6113
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3455225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR103150Medicare PIN