MEDICARE: KRISTEN HOLLOWAY 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
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1669102026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN HOLLOWAY PT

Provider Business Mailing Address
First Line	:	2195 VILLAGE PARK AVE STE 100
Second Line	:
City	:	TWIN FALLS
State	:	ID
Zip	:	83301-4172
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2195 VILLAGE PARK AVE STE 100
Second Line	:
City	:	TWIN FALLS
State	:	ID
Zip	:	83301-4172
Country	:	US
Telephone Number	:	208-644-3500
Fax Number	:	308-644-3501

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

Provider Enumeration Date	:	06/16/2022
Last Update Date	:	06/16/2022

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Directions to “ KRISTEN HOLLOWAY PT” Practice Location

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