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General NPI Number Information
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NPI Number | 1619522372
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Entity Type | Individual
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Provider Name | JACQUELYN NICOLE HOLTON PTA
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Gender | Female
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Dates
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Enumeration Date | 08/08/2019
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Last Update Date | 08/08/2019
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Provider Practice Location Address
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Address Line | 2910 MORGAN RD STE 110
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City | BESSEMER
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State | AL
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Zip | 35022-6476
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Country | US
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Telephone | 205-230-0400
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Fax | 205-230-0410
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Provider Business Mailing Address
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Address Line | 8205 PRESIDENTS DR
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City | HUMMELSTOWN
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State | PA
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Zip | 17036-8621
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Country | US
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Telephone | 717-839-2159
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Fax | 717-565-1104
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA9422
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License Number State | AL
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