Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 8526 | AZ |
N | 2251S0007X | Physical Therapist - Sports | ||
N | 2251X0800X | Physical Therapist - Orthopedic |
NPI | 1043544935 |
---|---|
Provider Name | Crystal Roma Holt |
First Address | Chandler, AZ 85249-5403 |
Second Address | Phoenix, AZ 85020 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2009 |
Last Update Date | 02/08/2012 |