Provider Demographics
NPI:1275049207
Name:LORD, HOLLY (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:LORD
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:
Other - Last Name:TOWNSEND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1221 21ST AVE NE APT D
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-1663
Mailing Address - Country:US
Mailing Address - Phone:828-234-8721
Mailing Address - Fax:
Practice Address - Street 1:2690 KELLY BLVD
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:NC
Practice Address - Zip Code:28610-7427
Practice Address - Country:US
Practice Address - Phone:828-459-8006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-28
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAT-30762255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer