Provider Demographics
NPI:1346615242
Name:MCDONALD, HOLLY (MPT, LMBT)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:MPT, LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 OAK BRANCH DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-2380
Mailing Address - Country:US
Mailing Address - Phone:336-294-0910
Mailing Address - Fax:
Practice Address - Street 1:7 OAK BRANCH DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-2380
Practice Address - Country:US
Practice Address - Phone:336-294-0910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-03
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12117225100000X
NC1668225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist