MEDICARE: MICHELLE HOLLOWAY

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
1	225200000X	Physical Therapy Assistant	PTA0000000396	TN

General Provider Information

NPI Number	:	1508495961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE HOLLOWAY

Provider Business Mailing Address
First Line	:	308 W WIND LN
Second Line	:
City	:	SPRING CITY
State	:	TN
Zip	:	37381-5780
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	308 W WIND LN
Second Line	:
City	:	SPRING CITY
State	:	TN
Zip	:	37381-5780
Country	:	US
Telephone Number	:	865-776-7542
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2020
Last Update Date	:	04/07/2020

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Directions to “ MICHELLE HOLLOWAY ” Practice Location

Language	Start Address	Practice Location

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