Healthcare Provider Details

I. General information

NPI: 1255420626
Provider Name (Legal Business Name): CAROL S HOLLENBECK P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROL H GLASSCOCK P.T.

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4615 GULF BLVD STE 116
ST PETE BEACH FL
33706-2454
US

IV. Provider business mailing address

4615 GULF BLVD STE 116
ST PETE BEACH FL
33706-2454
US

V. Phone/Fax

Practice location:
  • Phone: 727-367-0075
  • Fax: 727-367-0402
Mailing address:
  • Phone: 727-367-0075
  • Fax: 727-367-0402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License NumberPT#0008575
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: