Healthcare Provider Details

I. General information

NPI: 1265553689
Provider Name (Legal Business Name): AARON W HOLLY PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

828 W BELLEVUE ST
LESLIE MI
49251-9302
US

IV. Provider business mailing address

3073 SHIRLEY DR
JACKSON MI
49201-7010
US

V. Phone/Fax

Practice location:
  • Phone: 877-202-2175
  • Fax: 517-990-6212
Mailing address:
  • Phone: 517-990-6211
  • Fax: 517-990-6212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501010460
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: