Provider Demographics
NPI:1255633749
Name:HOLMES, WHITNEY (AT,PTA)
Entity type:Individual
Prefix:MRS
First Name:WHITNEY
Middle Name:
Last Name:HOLMES
Suffix:
Gender:F
Credentials:AT,PTA
Other - Prefix:MISS
Other - First Name:WHITNEY
Other - Middle Name:
Other - Last Name:TANNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AT
Mailing Address - Street 1:1018 HWY 80
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31017-2068
Mailing Address - Country:US
Mailing Address - Phone:478-290-6213
Mailing Address - Fax:
Practice Address - Street 1:101 FAIRVIEW PARK DRIVE
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-2501
Practice Address - Country:US
Practice Address - Phone:478-272-7494
Practice Address - Fax:478-272-2616
Is Sole Proprietor?:No
Enumeration Date:2010-12-03
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0018182255A2300X
GAPTA003171225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer