Provider Demographics
NPI:1346800505
Name:GROSS, HOLLY M (DPT)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:M
Last Name:GROSS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MRS
Other - First Name:HOLLY
Other - Middle Name:M
Other - Last Name:GROSS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:2804 GREENHILL BLVD NW STE 102
Mailing Address - Street 2:
Mailing Address - City:FORT PAYNE
Mailing Address - State:AL
Mailing Address - Zip Code:35968-3067
Mailing Address - Country:US
Mailing Address - Phone:256-979-1222
Mailing Address - Fax:256-979-1223
Practice Address - Street 1:2804 GREENHILL BLVD NW STE 102
Practice Address - Street 2:
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35968-3067
Practice Address - Country:US
Practice Address - Phone:256-979-1222
Practice Address - Fax:256-979-1223
Is Sole Proprietor?:No
Enumeration Date:2019-06-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH9372225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist