Provider Demographics
NPI:1437559713
Name:HOLLIDAY, CHARLIE (MS, ATC/LAT)
Entity Type:Individual
Prefix:
First Name:CHARLIE
Middle Name:
Last Name:HOLLIDAY
Suffix:
Gender:F
Credentials:MS, ATC/LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11200 SW 8TH ST
Mailing Address - Street 2:MODESTO MAIDIQUE, SHSC 160
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33199-2516
Mailing Address - Country:US
Mailing Address - Phone:305-348-5960
Mailing Address - Fax:305-348-0336
Practice Address - Street 1:11200 SW 8TH ST
Practice Address - Street 2:MODESTO MAIDIQUE, SHSC 160
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33199-2516
Practice Address - Country:US
Practice Address - Phone:305-348-5960
Practice Address - Fax:305-348-0336
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-24
Last Update Date:2014-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL33042255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer