Provider Demographics
NPI:1245796176
Name:HOLLANDSWORTH, JAMIE ANN
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:ANN
Last Name:HOLLANDSWORTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 FOREST VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:FOREST HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21050-2831
Mailing Address - Country:US
Mailing Address - Phone:410-776-6038
Mailing Address - Fax:
Practice Address - Street 1:109 FOREST VALLEY DR
Practice Address - Street 2:
Practice Address - City:FOREST HILL
Practice Address - State:MD
Practice Address - Zip Code:21050-2831
Practice Address - Country:US
Practice Address - Phone:410-776-6038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-15
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1144225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant