Michael Holmes, LAT, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

36003136A Issued in IN

Practice address

3946 Ice Way
Fort Wayne, IN 46805-1018

Phone

(260) 266-4005

NPI assigned

Jun 30, 2016

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1467244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740355200000",
    "number": "1386095412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1542 WEBSTER ST",
            "city": "WABASH",
            "state": "IN",
            "postal_code": "469923533",
            "telephone_number": "517-899-1879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3946 ICE WAY",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468051018",
            "telephone_number": "260-266-4005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLMES",
        "first_name": "MICHAEL",
        "credential": "LAT, ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-30",
        "last_updated": "2025-02-24",
        "certification_date": "2025-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "TX",
            "license": "AT6680",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "CO",
            "license": "AT.0001813",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "IN",
            "license": "36003136A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Malyssa L Holley, RBT
• Renee Kathleen Holley, NP-C
• Amber N Hollins, COTA
• Amelia Marie Holloway, PHARMD
• Patrick M. Holly, MD
• Ryan K Holmes, D.D.S.
• Anatasia Nicole Holscher, RBT
• Rebecca Anne Holsclaw, (TEMP) LSW
• Ashley N Holt, DPT
• Holtsclaw Medical Centre, LLC

• Athletic Trainer in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Athletic Trainer in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.