Provider Demographics
NPI:1801117239
Name:HOLT, MATTHEW TAMEICHI (DPT)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:TAMEICHI
Last Name:HOLT
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 757
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:NV
Mailing Address - Zip Code:89024
Mailing Address - Country:US
Mailing Address - Phone:702-346-1899
Mailing Address - Fax:702-346-8581
Practice Address - Street 1:1301 BERTHA HOWE AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:MESQUITE
Practice Address - State:NV
Practice Address - Zip Code:89027
Practice Address - Country:US
Practice Address - Phone:702-346-1899
Practice Address - Fax:702-346-8581
Is Sole Proprietor?:No
Enumeration Date:2010-06-21
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2436225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist