Provider Demographics
NPI:1134639222
Name:LILLARD, HOLLI DAWN (DPT)
Entity Type:Individual
Prefix:
First Name:HOLLI
Middle Name:DAWN
Last Name:LILLARD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:HOLLI
Other - Middle Name:
Other - Last Name:SPURLOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 334
Mailing Address - Street 2:
Mailing Address - City:IMBODEN
Mailing Address - State:AR
Mailing Address - Zip Code:72434-0334
Mailing Address - Country:US
Mailing Address - Phone:870-378-1950
Mailing Address - Fax:
Practice Address - Street 1:5552 US HWY 63
Practice Address - Street 2:SUITE B
Practice Address - City:IMBODEN
Practice Address - State:AR
Practice Address - Zip Code:72434
Practice Address - Country:US
Practice Address - Phone:870-869-7221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-03
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT2712225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist