Provider Demographics
NPI:1033387576
Name:HOLLAND, JIMMIE WAYNE II (PT)
Entity Type:Individual
Prefix:
First Name:JIMMIE
Middle Name:WAYNE
Last Name:HOLLAND
Suffix:II
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:JAY
Other - Middle Name:
Other - Last Name:HOLLAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:45 MINE HILL DR
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72118-5202
Mailing Address - Country:US
Mailing Address - Phone:501-940-5435
Mailing Address - Fax:
Practice Address - Street 1:45 MINE HILL DR
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72118-5202
Practice Address - Country:US
Practice Address - Phone:501-940-5435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT2678225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist