Provider Demographics
NPI:1912259250
Name:HOLT, ELIZABETH AVERETT (DPT)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:AVERETT
Last Name:HOLT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1466 10TH AVE
Mailing Address - Street 2:APT B
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-3603
Mailing Address - Country:US
Mailing Address - Phone:831-818-1147
Mailing Address - Fax:
Practice Address - Street 1:5980 STONERIDGE DR
Practice Address - Street 2:#100
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-4518
Practice Address - Country:US
Practice Address - Phone:925-847-8833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-10
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39422225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGT588ZMedicare PIN
CAGT588YMedicare PIN
CAZZZ06873ZMedicare PIN
CACP932Medicare PIN