Provider Demographics
NPI:1548635451
Name:HOLTHAUS, AMY K (DPT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:K
Last Name:HOLTHAUS
Suffix:
Gender:F
Credentials:DPT
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:588 N SUNRISE AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-2843
Mailing Address - Country:US
Mailing Address - Phone:916-782-7848
Mailing Address - Fax:916-782-7855
Practice Address - Street 1:11960 HERITAGE OAK PL
Practice Address - Street 2:SUITE 19
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-2401
Practice Address - Country:US
Practice Address - Phone:530-878-5301
Practice Address - Fax:530-878-5303
Is Sole Proprietor?:No
Enumeration Date:2015-12-02
Last Update Date:2016-01-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA43271225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA13668339OtherCAQH