Provider Demographics
NPI:1235297581
Name:HOLLOWAY, AARON
Entity Type:Individual
Prefix:MR
First Name:AARON
Middle Name:
Last Name:HOLLOWAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:HOLLOWAY
Other - Middle Name:REHABILITATION AND
Other - Last Name:PAI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:15622 SW 105TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-1411
Mailing Address - Country:US
Mailing Address - Phone:786-443-1367
Mailing Address - Fax:786-345-6916
Practice Address - Street 1:15622 SW 105TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-1411
Practice Address - Country:US
Practice Address - Phone:786-443-1367
Practice Address - Fax:786-345-6916
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT0001638174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL891154100Medicaid
FL106710Medicare Oscar/Certification