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NPI Code Detail

MEDICARE: HOLLY NEISWENDER PT

MEDICARE: HOLLY NEISWENDER PT
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
1222Q00000XDevelopmental TherapistPT0002911FL
2225100000XPhysical TherapistPTOOO2911FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1619913076
Entity Type Code : Individual
Provider Name (Legal Business Name) : HOLLY NEISWENDER PT
Provider Business Mailing Address
First Line : 2215 E HENRY AVE
Second Line :
City : TAMPA
State : FL
Zip : 33610-4432
Country : US
Telephone Number : 813-239-1179
Fax Number : 813-237-3091
Provider Business Practice Location Address
First Line : 2215 E HENRY AVE
Second Line :
City : TAMPA
State : FL
Zip : 33610-4432
Country : US
Telephone Number : 813-239-1179
Fax Number : 813-237-3091
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2006
Last Update Date : 02/15/2011

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