Basic Information
| Provider Information | |||||||||
| NPI: | 1225327166 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOLMES | ||||||||
| FirstName: | LORETTA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | BUILDING 4-2817 REILLY ROAD | ||||||||
| Address2: | |||||||||
| City: | FORT BRAGG | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9109076000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4-2817 REILLY ROAD | ||||||||
| Address2: | BUILDING 4-2817 | ||||||||
| City: | FORT BRAGG | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9109076000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2011 | ||||||||
| LastUpdateDate: | 03/31/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 6682 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.