Provider Demographics
NPI:1235107764
Name:MCCULLEY, HOLLIE MARIE (DPT)
Entity Type:Individual
Prefix:
First Name:HOLLIE
Middle Name:MARIE
Last Name:MCCULLEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:HOLLIE
Other - Middle Name:MARIE
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1003 GROVE RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4623
Mailing Address - Country:US
Mailing Address - Phone:864-233-5128
Mailing Address - Fax:864-271-2599
Practice Address - Street 1:1910 COMMONWEALTH LN
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-2054
Practice Address - Country:US
Practice Address - Phone:864-964-0505
Practice Address - Fax:864-222-0182
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012726225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist