Provider Demographics
NPI:1104942226
Name:HOLDRIDGE, BETH A (PTA)
Entity type:Individual
Prefix:MRS
First Name:BETH
Middle Name:A
Last Name:HOLDRIDGE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 SOUTH 16TH STREET #106
Mailing Address - Street 2:
Mailing Address - City:BLAIR
Mailing Address - State:NE
Mailing Address - Zip Code:68008-1815
Mailing Address - Country:US
Mailing Address - Phone:402-429-3521
Mailing Address - Fax:
Practice Address - Street 1:245 S 22ND ST
Practice Address - Street 2:
Practice Address - City:BLAIR
Practice Address - State:NE
Practice Address - Zip Code:68008-1811
Practice Address - Country:US
Practice Address - Phone:402-424-2177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE504225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant