Provider Demographics
NPI:1467097790
Name:NETTEKOVEN, HOLLY MARIE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:MARIE
Last Name:NETTEKOVEN
Suffix:
Gender:F
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 1:260 FORT SANDERS WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3355
Mailing Address - Country:US
Mailing Address - Phone:865-558-4491
Mailing Address - Fax:865-558-4493
Practice Address - Street 1:260 FORT SANDERS WEST BLVD STE 110
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3355
Practice Address - Country:US
Practice Address - Phone:865-558-4491
Practice Address - Fax:865-558-4493
Is Sole Proprietor?:No
Enumeration Date:2019-11-11
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9987225100000X
GAPT014517225100000X
TN13513225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist