Provider Demographics
NPI:1982902417
Name:HORIKAWA, HOLLY (PT, DPT, CLT)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:HORIKAWA
Suffix:
Gender:F
Credentials:PT, DPT, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18384 BROOKHURST ST
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-6704
Mailing Address - Country:US
Mailing Address - Phone:714-963-3322
Mailing Address - Fax:714-963-3323
Practice Address - Street 1:18384 BROOKHURST ST
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-6704
Practice Address - Country:US
Practice Address - Phone:714-963-3322
Practice Address - Fax:714-963-3323
Is Sole Proprietor?:No
Enumeration Date:2011-03-08
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32071225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT32071OtherPT LICENSE
CAPT32071OtherPT LICENSE