Healthcare Provider Details

I. General information

NPI: 1225777949
Provider Name (Legal Business Name): MADISON ROSE HOLLIDAY DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MADISON ROSE HOTELLING

II. Dates (important events)

Enumeration Date: 06/01/2022
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1921 PRESTON RD STE 2074
PLANO TX
75093-5124
US

IV. Provider business mailing address

1200 CORPORATE DR STE 400
HOOVER AL
35242-5424
US

V. Phone/Fax

Practice location:
  • Phone: 972-905-6622
  • Fax: 972-942-4073
Mailing address:
  • Phone: 423-541-5492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1361223
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: