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NPI Code Detail

MEDICARE: KIMBERLY HOLLIE PTA

MEDICARE: KIMBERLY HOLLIE PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant2065246TX

General Provider Information

NPI Number : 1194030973
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY HOLLIE PTA
Provider Business Mailing Address
First Line : 3001 SPRING FOREST RD
Second Line :
City : RALEIGH
State : NC
Zip : 27616-2815
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3201 RIVER PARK DR
Second Line :
City : FORT WORTH
State : TX
Zip : 76116-9533
Country : US
Telephone Number : 817-732-3636
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/17/2010
Last Update Date : 08/17/2010

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Directions to “ KIMBERLY HOLLIE PTA” Practice Location

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