Provider Demographics
NPI:1902122963
Name:HOLT, WILLIAM RAYMOND JR (PT)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:RAYMOND
Last Name:HOLT
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:374 NE CAMELOT DR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-1744
Mailing Address - Country:US
Mailing Address - Phone:772-626-4012
Mailing Address - Fax:
Practice Address - Street 1:2401 FRIST BLVD
Practice Address - Street 2:SUITE 7
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4839
Practice Address - Country:US
Practice Address - Phone:772-489-9519
Practice Address - Fax:772-460-8555
Is Sole Proprietor?:No
Enumeration Date:2010-04-15
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT40582251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic