Provider Demographics
NPI:1285863456
Name:HOLLOCK-SINCLAIR, JESSICA (MS, PT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:HOLLOCK-SINCLAIR
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 PHILADELPHIA STREET
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701
Mailing Address - Country:US
Mailing Address - Phone:724-463-7478
Mailing Address - Fax:724-463-0931
Practice Address - Street 1:311 MARKET ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5428
Practice Address - Country:US
Practice Address - Phone:570-711-8093
Practice Address - Fax:570-718-0938
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT019202225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA396749Medicare PIN