Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | PTA-6781 | ID |
NPI | 1053936054 |
---|---|
Provider Name | Danielle Holman |
First Address | Clarkston, WA 99403-5005 |
Second Address | Clarkston, WA 99403-5005 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2020 |
Last Update Date | 08/12/2020 |