Healthcare Provider Details

I. General information

NPI: 1639361207
Provider Name (Legal Business Name): HOLLYFIELD PHYSICAL THERAPY, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2007
Last Update Date: 08/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 BRYAN POINT RD
ACCOKEEK MD
20607-2348
US

IV. Provider business mailing address

821 BRYAN POINT ROAD
ACCOKEEK MD
20607
US

V. Phone/Fax

Practice location:
  • Phone: 301-292-4074
  • Fax: 301-292-4074
Mailing address:
  • Phone: 301-292-4074
  • Fax: 301-292-4074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number15965
License Number StateMD

VIII. Authorized Official

Name: MS. LYNN D HOLLYFIELD
Title or Position: PRESIDENT
Credential: MSPT
Phone: 301-292-4074