Provider Demographics
NPI:1326103342
Name:JONELY, HOLLY (PT)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:JONELY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 16TH ST NW
Mailing Address - Street 2:STE 200
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-4823
Mailing Address - Country:US
Mailing Address - Phone:202-223-1737
Mailing Address - Fax:202-223-1738
Practice Address - Street 1:1112 16TH ST NW
Practice Address - Street 2:STE 200
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-4823
Practice Address - Country:US
Practice Address - Phone:202-223-1737
Practice Address - Fax:202-223-1738
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1664225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPT6111Medicaid
AKPT6111Medicaid