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General NPI Number Information
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NPI Number | 1255960944
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Entity Type | Organization
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Legal Business Name | HOLYSTICK,LLC
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Dates
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Enumeration Date | 04/03/2020
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Last Update Date | 11/29/2023
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Provider Practice Location Address
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Address Line | 15200 SHADY GROVE RD STE 103
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City | ROCKVILLE
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State | MD
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Zip | 20850-3218
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Country | US
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Telephone | 240-945-8525
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Fax | 240-901-4515
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Provider Business Mailing Address
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Address Line | 14428 HOMECREST RD
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City | SILVER SPRING
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State | MD
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Zip | 20906-1820
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Country | US
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Telephone | 240-506-6549
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | HANUL JUNG
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Credential | DOA
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Telephone | 240-945-8525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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