Basic Information
| Provider Information | |||||||||
| NPI: | 1356558027 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOLMES | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 350 SOUTH MAIN STREET | ||||||||
| Address2: | SUITE 315 | ||||||||
| City: | DOYLESTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 18901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154898760 | ||||||||
| FaxNumber: | 2154898766 | ||||||||
| Practice Location | |||||||||
| Address1: | 350 SOUTH MAIN STREET | ||||||||
| Address2: | SUITE 315 | ||||||||
| City: | DOYLESTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 18901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154898760 | ||||||||
| FaxNumber: | 2154898766 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT003665L | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 0019267900003 | 01 | PA | MA # | OTHER |