Individual
MICHAEL HOLMES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAT, ATC
Contact information
Practice address
3946 ICE WAY, FORT WAYNE, IN 46805-1018
(260) 266-4005
Mailing address
1542 WEBSTER ST, WABASH, IN 46992-3533
(517) 899-1879
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36003136A
IN
2255A2300X
Athletic Trainer
AT.0001813
CO
2255A2300X
Athletic Trainer
AT6680
TX
Other
Enumeration date
06/30/2016
Last updated
02/24/2025
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