Provider Demographics
NPI:1104344597
Name:HOLZBERGER, KELLY LYNN (MS, LAT, ATC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:LYNN
Last Name:HOLZBERGER
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2860 HILYER DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-2243
Mailing Address - Country:US
Mailing Address - Phone:845-546-0087
Mailing Address - Fax:
Practice Address - Street 1:2860 HILYER DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-2243
Practice Address - Country:US
Practice Address - Phone:845-546-0087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-06
Last Update Date:2021-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer