Healthcare Provider Details

I. General information

NPI: 1700083987
Provider Name (Legal Business Name): HOLLY HENDRICKSON PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1804 WASHINGTON BLVD STE E
BELPRE OH
45714-3501
US

IV. Provider business mailing address

28378 TORCH RD
COOLVILLE OH
45723-9706
US

V. Phone/Fax

Practice location:
  • Phone: 740-423-3084
  • Fax: 740-423-5600
Mailing address:
  • Phone: 740-373-3597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberCP010267A
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number004400
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: