Provider Demographics
NPI:1417182817
Name:HOLLANDER, KELLY A (PT)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:A
Last Name:HOLLANDER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:KELLY
Other - Middle Name:A
Other - Last Name:SCHMID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:10723 FARADAY DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123-6038
Mailing Address - Country:US
Mailing Address - Phone:314-843-0016
Mailing Address - Fax:
Practice Address - Street 1:439 S KIRKWOOD RD
Practice Address - Street 2:SUITE 204
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122-6169
Practice Address - Country:US
Practice Address - Phone:314-822-6297
Practice Address - Fax:314-822-6298
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO100836225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist