Provider Demographics
NPI:1952698359
Name:HOLDEN, JEANNIE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:JEANNIE
Middle Name:
Last Name:HOLDEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 JONES ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIA
Mailing Address - State:WI
Mailing Address - Zip Code:53923-8835
Mailing Address - Country:US
Mailing Address - Phone:920-319-0706
Mailing Address - Fax:
Practice Address - Street 1:123 JONES ST
Practice Address - Street 2:
Practice Address - City:CAMBRIA
Practice Address - State:WI
Practice Address - Zip Code:53923-8835
Practice Address - Country:US
Practice Address - Phone:920-319-0706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11691-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist