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General NPI Number Information
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NPI Number | 1114239779
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Entity Type | Individual
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Provider Name | JILLIAN KATE HOLSONBACK PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 07/11/2010
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Last Update Date | 08/20/2018
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Provider Practice Location Address
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Address Line | 304 EMORY ST
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City | VALDOSTA
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State | GA
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Zip | 31602
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Country | US
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Telephone | 229-244-1667
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Fax | 229-244-8253
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Provider Business Mailing Address
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Address Line | 304 EMORY ST
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City | VALDOSTA
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State | GA
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Zip | 31602-1808
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Country | US
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Telephone | 229-244-1667
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Fax | 229-244-8253
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 15271
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT013371
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License Number State | GA
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