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General NPI Number Information
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NPI Number | 1881810646
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Entity Type | Individual
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Provider Name | KENNETH DANIEL HOLLINGSWORTH P.T.
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Gender | Male
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 550 JESSUP RD
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City | PAULSBORO
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State | NJ
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Zip | 08066-1921
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Country | US
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Telephone | 856-848-9551
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Fax |
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Provider Business Mailing Address
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Address Line | 19 WESTERLY DR
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City | SICKLERVILLE
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State | NJ
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Zip | 08081-3031
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Country | US
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Telephone | 856-404-9262
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Fax |
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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 | 40QA01128000
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License Number State | NJ
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