MEDICARE: ELIZABETH 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	PTA4846	AR

General Provider Information

NPI Number	:	1588344147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH HOLLOWAY

Provider Business Mailing Address
First Line	:	56 KIOWA DR
Second Line	:
City	:	CHEROKEE VILLAGE
State	:	AR
Zip	:	72529-5913
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	685 SHELBY TRL STE 1
Second Line	:
City	:	CONWAY
State	:	AR
Zip	:	72034-7167
Country	:	US
Telephone Number	:	501-358-6868
Fax Number	:

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

Provider Enumeration Date	:	07/19/2023
Last Update Date	:	07/19/2023

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Directions to “ ELIZABETH HOLLOWAY ” Practice Location

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