Provider Demographics
NPI:1548639511
Name:HOLT, ASHLEY N (DPT)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:N
Last Name:HOLT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5310 MERCHANDISE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825
Mailing Address - Country:US
Mailing Address - Phone:260-484-9491
Mailing Address - Fax:260-484-9451
Practice Address - Street 1:5310 MERCHANDISE DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825
Practice Address - Country:US
Practice Address - Phone:260-484-9491
Practice Address - Fax:260-484-9451
Is Sole Proprietor?:No
Enumeration Date:2015-09-21
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070021537225100000X
IN05013558A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist