Healthcare Provider Details

I. General information

NPI: 1104897578
Provider Name (Legal Business Name): DANNY JOE HOLLINGSWORTH P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 12/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COMNAVAIRFOR BOCX 357071 NAS NI
SAN DIEGO CA
92135-7051
US

IV. Provider business mailing address

2593 NE KEVOS POND DR
POULSBO WA
98370-6320
US

V. Phone/Fax

Practice location:
  • Phone: 619-545-1148
  • Fax: 619-767-7417
Mailing address:
  • Phone: 619-545-1148
  • Fax: 619-767-7417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT00009845
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT00009845
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: