Active NPI
Theresa A Holden, PT
- Pediatric Physical Therapist
- Salt Lake, UT
National Provider Identifier
1669565131
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Physical Therapist
- License
- 110220-2401
- Practice address
- 44 Medical Drive
Salt Lake, UT 84113 - Phone
- (801) 584-8521
- NPI assigned
- Oct 2, 2006
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pediatric Physical Therapist | 2251P0200X | 110220-2401 | UT | Primary |
Addresses
Primary practice location
44 Medical Drive
Salt Lake, UT 84113
Mailing address
3020 S Melbourne Street
Salt Lake, UT 84106
Phone (801) 467-4637
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 999000021002 | Medicaid | UT | |
| 1699878942 | Other | UT | UDOH CFHS |
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 |
|---|---|---|---|
| 110220-2401 | UT | MD | Pediatric Physical Therapist |
Interoperability endpoints
- theresaholden@mgh.allscriptsdirect.net
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1669565131",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3020 S MELBOURNE STREET",
"city": "SALT LAKE",
"state": "UT",
"postal_code": "84106",
"telephone_number": "801-467-4637"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "44 MEDICAL DRIVE",
"city": "SALT LAKE",
"state": "UT",
"postal_code": "84113",
"telephone_number": "801-584-8521"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLDEN",
"first_name": "THERESA",
"middle_name": "A",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-02",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "2251P0200X",
"taxonomy_group": "",
"desc": "Physical Therapist, Pediatrics",
"state": "UT",
"license": "110220-2401",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "999000021002",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UDOH CFHS",
"identifier": "1699878942",
"state": "UT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Salt Lake, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.