Provider Demographics
NPI:1861788705
Name:HOLDEN, JOHN WILLIAM (MPT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:WILLIAM
Last Name:HOLDEN
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:454 W NAPA ST
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-6519
Mailing Address - Country:US
Mailing Address - Phone:707-939-3810
Mailing Address - Fax:
Practice Address - Street 1:454 W NAPA ST
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-6519
Practice Address - Country:US
Practice Address - Phone:707-939-3810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 19796225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist