Provider Demographics
NPI:1356558027
Name:HOLMES, MARY M
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:M
Last Name:HOLMES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 SOUTH MAIN STREET
Mailing Address - Street 2:SUITE 315
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901
Mailing Address - Country:US
Mailing Address - Phone:215-489-8760
Mailing Address - Fax:215-489-8766
Practice Address - Street 1:350 SOUTH MAIN STREET
Practice Address - Street 2:SUITE 315
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901
Practice Address - Country:US
Practice Address - Phone:215-489-8760
Practice Address - Fax:215-489-8766
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT003665L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019267900003OtherMA #