Provider Demographics
NPI:1356673636
Name:HOLUBAR, MONA A (PT)
Entity type:Individual
Prefix:
First Name:MONA
Middle Name:A
Last Name:HOLUBAR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MONA
Other - Middle Name:A
Other - Last Name:KHAMIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:750 E THUNDERBIRD RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-5306
Mailing Address - Country:US
Mailing Address - Phone:602-866-1255
Mailing Address - Fax:602-863-7713
Practice Address - Street 1:750 E THUNDERBIRD RD
Practice Address - Street 2:SUITE 1
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-5306
Practice Address - Country:US
Practice Address - Phone:602-866-1255
Practice Address - Fax:602-863-7713
Is Sole Proprietor?:No
Enumeration Date:2010-02-11
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8786225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist