Provider Demographics
NPI:1750939542
Name:HOLMES, TAYLOR MARIE (DPT)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:MARIE
Last Name:HOLMES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:MARIE
Other - Last Name:PESTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:3506 THOMAS DR
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14480-9730
Mailing Address - Country:US
Mailing Address - Phone:585-346-0060
Mailing Address - Fax:
Practice Address - Street 1:3506 THOMAS DR
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:NY
Practice Address - Zip Code:14480-9730
Practice Address - Country:US
Practice Address - Phone:585-346-0060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-27
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044754225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist