Provider Demographics
NPI:1427018407
Name:HOLLAND, KELLY LYNN (MPT)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:LYNN
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:LYNN
Other - Last Name:BURKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:3503 SHADOW BAYOU CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082
Mailing Address - Country:US
Mailing Address - Phone:281-679-7196
Mailing Address - Fax:
Practice Address - Street 1:11811 FM 1960 WEST
Practice Address - Street 2:SUITE 102
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065
Practice Address - Country:US
Practice Address - Phone:281-469-8163
Practice Address - Fax:281-469-5559
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1131357225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX89970TOtherBCBS