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NPI Code Detail

MEDICARE: SANDRA JEAN HOLLOWELL MSPT

MEDICARE: SANDRA JEAN HOLLOWELL MSPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist05004055AIN
2225100000XPhysical TherapistPT294593CA

General Provider Information

NPI Number : 1124178686
Entity Type Code : Individual
Provider Name (Legal Business Name) : SANDRA JEAN HOLLOWELL MSPT
Provider Business Mailing Address
First Line : 147 S GRETNA GREEN WAY
Second Line :
City : LOS ANGELES
State : CA
Zip : 90049-4015
Country : US
Telephone Number : 574-329-1781
Fax Number :
Provider Business Practice Location Address
First Line : 435 N BEDFORD DR STE 102
Second Line :
City : BEVERLY HILLS
State : CA
Zip : 90210-4319
Country : US
Telephone Number : 310-385-9064
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/10/2007
Last Update Date : 05/24/2018

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Directions to “ SANDRA JEAN HOLLOWELL MSPT” Practice Location

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