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General NPI Number Information
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NPI Number | 1912274820
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Entity Type | Individual
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Provider Name | LISSETTE HOLLAND P.T.
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Gender | Female
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Dates
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Enumeration Date | 11/20/2011
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Last Update Date | 11/20/2011
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Provider Practice Location Address
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Address Line | 219 MAIN ST STE A
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City | PINEVILLE
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State | NC
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Zip | 28134-7528
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Country | US
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Telephone | 704-780-4586
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Fax |
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Provider Business Mailing Address
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Address Line | 16002 PRESCOTT HILL AVE
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City | CHARLOTTE
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State | NC
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Zip | 28277-2923
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Country | US
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Telephone | 704-942-1476
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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 | 9691
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License Number State | NC
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