Provider Demographics
NPI:1124178686
Name:HOLLOWELL, SANDRA JEAN (MSPT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:JEAN
Last Name:HOLLOWELL
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 S GRETNA GREEN WAY
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-4015
Mailing Address - Country:US
Mailing Address - Phone:574-329-1781
Mailing Address - Fax:
Practice Address - Street 1:435 N BEDFORD DR STE 102
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4319
Practice Address - Country:US
Practice Address - Phone:310-385-9064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05004055A225100000X
CAPT294593225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist