Provider Demographics
NPI:1902314636
Name:MEYER, HOLLY (PT)
Entity type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:
Last Name:MEYER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1782 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:WYANDOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48192-4805
Mailing Address - Country:US
Mailing Address - Phone:734-282-2193
Mailing Address - Fax:
Practice Address - Street 1:16125 DIX TOLEDO RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2948
Practice Address - Country:US
Practice Address - Phone:734-285-1070
Practice Address - Fax:734-285-1073
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-16
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501004180225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist