Provider Demographics
NPI:1063512168
Name:HOLMES, JESSICA MILLS (DPT)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:MILLS
Last Name:HOLMES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LEIGH
Other - Last Name:MILLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:11030 RAVEN RIDGE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-8512
Mailing Address - Country:US
Mailing Address - Phone:919-844-6611
Mailing Address - Fax:919-844-6612
Practice Address - Street 1:11030 RAVEN RIDGE RD STE 101
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-8512
Practice Address - Country:US
Practice Address - Phone:919-844-6611
Practice Address - Fax:919-844-6612
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10752225100000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7212138Medicaid