Active NPI
Katie Holly
- Mechanotherapist
- Newport Beach, CA
National Provider Identifier
1407301070
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mechanotherapist
- License
- 18516
- Practice address
- 20072 SW Birch St Ste 190
Newport Beach, CA 92660-0799 - Phone
- (949) 673-8088
- NPI assigned
- Aug 23, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mechanotherapist | 172M00000X | 18516 | CA | Primary |
Addresses
Primary practice location
20072 SW Birch St Ste 190
Newport Beach, CA 92660-0799
Mailing address
851 Domingo Dr Apt 24
Newport Beach, CA 92660-4578
Phone (949) 274-0248
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18516 | CA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1471910400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1471910400000",
"number": "1407301070",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "851 DOMINGO DR APT 24",
"city": "NEWPORT BEACH",
"state": "CA",
"postal_code": "926604578",
"telephone_number": "949-274-0248"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20072 SW BIRCH ST STE 190",
"city": "NEWPORT BEACH",
"state": "CA",
"postal_code": "926600799",
"telephone_number": "949-673-8088"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLLY",
"first_name": "KATIE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-08-23",
"last_updated": "2016-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "172M00000X",
"taxonomy_group": "",
"desc": "Mechanotherapist",
"state": "CA",
"license": "18516",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Newport Beach, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.