Healthcare Provider Details

I. General information

NPI: 1962745000
Provider Name (Legal Business Name): JAY WILLIAM HOLLIDAY RKT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2013
Last Update Date: 03/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3707 LOOP RD. TUSCALOOSA VA MEDICAL CENTER
TUSCALOOSA AL
35404
US

IV. Provider business mailing address

3707 LOOP RD. TUSCALOOSA VA MEDICAL CENTER
TUSCALOOSA AL
35404
US

V. Phone/Fax

Practice location:
  • Phone: 205-554-2822
  • Fax: 205-554-2894
Mailing address:
  • Phone: 205-554-2822
  • Fax: 205-554-2894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number1689
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: