Provider Demographics
NPI:1417582750
Name:JOHNSON, HOLLY LYNNE (PT)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:LYNNE
Last Name:JOHNSON
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 1:4112 CAROLINA LILY ST
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-6712
Mailing Address - Country:US
Mailing Address - Phone:734-478-9413
Mailing Address - Fax:
Practice Address - Street 1:103 PARKWAY OFFICE CT STE 102
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7429
Practice Address - Country:US
Practice Address - Phone:919-615-3527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-06
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP19383225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist