Provider Demographics
NPI:1043762289
Name:HOLLOWAY, KIMBERELY (DPT)
Entity Type:Individual
Prefix:
First Name:KIMBERELY
Middle Name:
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 S MAIN ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76244
Mailing Address - Country:US
Mailing Address - Phone:312-882-7386
Mailing Address - Fax:334-593-8032
Practice Address - Street 1:1211 S MAIN ST STE 500
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-0822
Practice Address - Country:US
Practice Address - Phone:312-882-7386
Practice Address - Fax:334-593-8032
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1261798225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist