Basic Information
| Provider Information | |||||||||
| NPI: | 1457435091 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOLMES | ||||||||
| FirstName: | KATHARINE | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3482 | ||||||||
| Address2: | |||||||||
| City: | POST FALLS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838773482 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087779740 | ||||||||
| FaxNumber: | 2087778316 | ||||||||
| Practice Location | |||||||||
| Address1: | 104 W 9TH AVE | ||||||||
| Address2: | |||||||||
| City: | POST FALLS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838549216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087779740 | ||||||||
| FaxNumber: | 2087778316 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2006 | ||||||||
| LastUpdateDate: | 10/06/2016 | ||||||||
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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 | PT-718 | ID | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 807306600 | 05 | ID | MEDICAID |