Provider Demographics
NPI:1215979489
Name:HOLMAN, KELLY STEVEN (PT, MS)
Entity type:Individual
Prefix:MR
First Name:KELLY
Middle Name:STEVEN
Last Name:HOLMAN
Suffix:
Gender:M
Credentials:PT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 51246
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42102-5546
Mailing Address - Country:US
Mailing Address - Phone:270-726-6640
Mailing Address - Fax:
Practice Address - Street 1:208 S COURT ST
Practice Address - Street 2:
Practice Address - City:SCOTTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42164-1263
Practice Address - Country:US
Practice Address - Phone:270-239-6640
Practice Address - Fax:270-239-6674
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPT-003727225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0719407Medicare PIN