Provider Demographics
NPI:1376525386
Name:HOLLAND, RANDY C
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:C
Last Name:HOLLAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15953
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33766-5953
Mailing Address - Country:US
Mailing Address - Phone:727-797-9090
Mailing Address - Fax:813-749-8992
Practice Address - Street 1:800 PHILLIES DR
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33755-4337
Practice Address - Country:US
Practice Address - Phone:727-797-9090
Practice Address - Fax:813-749-8992
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer