Provider Demographics
NPI:1659718690
Name:HOLTON, KELLY MARIE (DPT)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:MARIE
Last Name:HOLTON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:MARIE
Other - Last Name:SUFKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:340 POLARIS PKWY
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-7971
Mailing Address - Country:US
Mailing Address - Phone:614-839-2300
Mailing Address - Fax:614-839-2301
Practice Address - Street 1:340 POLARIS PKWY
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-7971
Practice Address - Country:US
Practice Address - Phone:614-839-2300
Practice Address - Fax:614-839-2301
Is Sole Proprietor?:No
Enumeration Date:2013-05-31
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT014187225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist