Provider Demographics
NPI:1124067400
Name:HOLDER, ALICE DORWORTH (PT, MHS)
Entity type:Individual
Prefix:MS
First Name:ALICE
Middle Name:DORWORTH
Last Name:HOLDER
Suffix:
Gender:F
Credentials:PT, MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8471 SHUMAN LN
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-5736
Mailing Address - Country:US
Mailing Address - Phone:513-931-0011
Mailing Address - Fax:
Practice Address - Street 1:3200 VINE ST
Practice Address - Street 2:CINCINNATI VAMC MDP 117
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45220-2213
Practice Address - Country:US
Practice Address - Phone:513-861-3100
Practice Address - Fax:513-487-6624
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT0071912251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics