Provider Demographics
NPI:1437864592
Name:HOLLY, GRANT S (PT, DPT)
Entity Type:Individual
Prefix:
First Name:GRANT
Middle Name:S
Last Name:HOLLY
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10333 CLAY RD APT 2054
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77041-4509
Mailing Address - Country:US
Mailing Address - Phone:832-265-6944
Mailing Address - Fax:
Practice Address - Street 1:16636 HOUSE HAHL RD
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-5357
Practice Address - Country:US
Practice Address - Phone:832-810-0274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1364456225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist