Provider Demographics
NPI:1700907367
Name:HOLINGER, ALICE JEAN (PT)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:JEAN
Last Name:HOLINGER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3761 PALMDALE DR
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-6611
Mailing Address - Country:US
Mailing Address - Phone:907-376-2340
Mailing Address - Fax:907-373-9124
Practice Address - Street 1:3750 E COUNTRY FIELD CIR
Practice Address - Street 2:#A
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-6689
Practice Address - Country:US
Practice Address - Phone:907-376-7334
Practice Address - Fax:907-373-9124
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK82225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPT0082Medicaid
AKPT0082Medicaid