Provider Demographics
NPI:1861619900
Name:HOLM, KARENA LEE (PT)
Entity type:Individual
Prefix:MS
First Name:KARENA
Middle Name:LEE
Last Name:HOLM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KAREY
Other - Middle Name:
Other - Last Name:HOLM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:3166 24TH AVE S
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-5861
Mailing Address - Country:US
Mailing Address - Phone:701-215-2148
Mailing Address - Fax:
Practice Address - Street 1:2200 LIBRARY CIR
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201
Practice Address - Country:US
Practice Address - Phone:701-757-2155
Practice Address - Fax:701-757-2156
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND007752251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics