Provider Demographics
NPI:1093081366
Name:VANCLEAVE, HOLLY BETH (PT, DPT, ATC)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:BETH
Last Name:VANCLEAVE
Suffix:
Gender:F
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:BETH
Other - Last Name:TREADWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT, ATC
Mailing Address - Street 1:520 S SANTA FE AVE
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-4190
Mailing Address - Country:US
Mailing Address - Phone:785-452-6668
Mailing Address - Fax:785-452-7512
Practice Address - Street 1:520 S SANTA FE AVE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-4190
Practice Address - Country:US
Practice Address - Phone:785-452-6668
Practice Address - Fax:785-452-7512
Is Sole Proprietor?:No
Enumeration Date:2012-03-30
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-05160225100000X
KS24010792255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer