Brian Holaday

Individual provider Active NPI Physical Therapy Assistant · Cameron, MO

NPI 1851789374 · NPPES record last updated Jan 6, 2015

Key facts

NPI
1851789374
Entity type
Individual (NPI type 1)
Primary specialty
Physical Therapy Assistant 225200000X
License
2013041292 (MO)
Practice address
801 Euclid Ave
Cameron, MO 64429-2003
Phone
(816) 596-6870
NPI assigned
Jan 6, 2015
Sex
Male
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
14-02561KSMDPhysical Therapy Assistant
2013041292MOMDPhysical Therapy Assistant

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X 2013041292 MO Yes
Physical Therapy Assistant 225200000X 14-02561 KS

Addresses

Primary practice location

801 Euclid Ave
Cameron, MO 64429-2003

Mailing address

801 Euclid Ave
Cameron, MO 64429-2003
Phone (816) 596-6870

Other providers in Cameron, MO

All providers in Cameron, MO · Physical Therapy Assistant in Missouri

Sources for this page

Verify at the official NPI Registry.