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General NPI Number Information
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NPI Number | 1043484900
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Entity Type | Organization
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Legal Business Name | THE HOLLOWAY REHABILITATION AND PAIN CENTER INC
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Dates
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Enumeration Date | 04/22/2008
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Last Update Date | 08/09/2012
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Provider Practice Location Address
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Address Line | 12245 SW 112TH ST
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City | MIAMI
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State | FL
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Zip | 33186-4830
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Country | US
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Telephone | 305-598-9696
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Fax | 305-598-4479
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Provider Business Mailing Address
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Address Line | 12245 SW 112TH ST
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City | MIAMI
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State | FL
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Zip | 33186-4830
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Country | US
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Telephone | 305-598-9696
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Fax | 305-598-4479
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Authorized Official
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Title or Position | MANAGER
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Name | MS. VANESSA HOLLOWAY
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Credential |
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Telephone | 305-598-9696
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT0001638
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License Number State | FL
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