Provider Demographics
NPI:1912320789
Name:HOLT, MICHELLE RENEE (LAT,ATC)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:RENEE
Last Name:HOLT
Suffix:
Gender:F
Credentials:LAT,ATC
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:RENEE
Other - Last Name:VRYHOF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAT,ATC
Mailing Address - Street 1:2106 RIVERFOREST COURT
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017
Mailing Address - Country:US
Mailing Address - Phone:559-816-7901
Mailing Address - Fax:
Practice Address - Street 1:3719 PACIFIC CT APT 173
Practice Address - Street 2:
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76109-3977
Practice Address - Country:US
Practice Address - Phone:559-816-7901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-29
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT57082255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer