Provider Demographics
NPI:1023221868
Name:HOLLAND, CLAY R (DPT, OCS,MTC)
Entity Type:Individual
Prefix:MR
First Name:CLAY
Middle Name:R
Last Name:HOLLAND
Suffix:
Gender:M
Credentials:DPT, OCS,MTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 W WINDCREST ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-4465
Mailing Address - Country:US
Mailing Address - Phone:830-997-1357
Mailing Address - Fax:
Practice Address - Street 1:402 W WINDCREST ST
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-4465
Practice Address - Country:US
Practice Address - Phone:830-997-1357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1174176225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist