Provider Demographics
NPI:1396836953
Name:JOLLAY, HEATHER MICHELLE (PT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:MICHELLE
Last Name:JOLLAY
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 1:1201 BLEACHERY BLVD
Mailing Address - Street 2:SUITE # 201
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-8314
Mailing Address - Country:US
Mailing Address - Phone:828-277-5763
Mailing Address - Fax:828-277-5764
Practice Address - Street 1:1201 BLEACHERY BLVD
Practice Address - Street 2:SUITE # 201
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-8314
Practice Address - Country:US
Practice Address - Phone:828-277-5763
Practice Address - Fax:828-277-5764
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8761225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8761OtherSTATE LISCENCE ROAD