Provider Demographics
NPI:1225027444
Name:HABEEB, HOLLY DANIELLE (MS PT)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:DANIELLE
Last Name:HABEEB
Suffix:
Gender:F
Credentials:MS PT
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Mailing Address - Street 1:PO BOX 740041
Mailing Address - Street 2:DEPT 6150
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-7441
Mailing Address - Country:US
Mailing Address - Phone:502-561-4263
Mailing Address - Fax:502-561-4221
Practice Address - Street 1:225 ABRAHAM FLEXNER WAY
Practice Address - Street 2:SUITE 650
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1846
Practice Address - Country:US
Practice Address - Phone:502-561-4263
Practice Address - Fax:502-561-4221
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2016-09-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY004119225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200850190Medicaid
IN233630JMedicare PIN
IN200850190Medicaid