Provider Demographics
NPI:1700977303
Name:HOLISTIC PHYSICAL THERAPY SPECIALIST,LLC
Entity Type:Organization
Organization Name:HOLISTIC PHYSICAL THERAPY SPECIALIST,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:CIMMA-LARIVIERE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:413-658-0039
Mailing Address - Street 1:256 N PLEASANT STREET STE 2A
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-1729
Mailing Address - Country:US
Mailing Address - Phone:413-658-0039
Mailing Address - Fax:413-658-0040
Practice Address - Street 1:256 N PLEASANT ST STE 2A
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-1729
Practice Address - Country:US
Practice Address - Phone:413-658-0039
Practice Address - Fax:413-658-0040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8184261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPT0231Medicare PIN