Provider Demographics
NPI:1477734259
Name:HOLLIS, JOAN C (PT)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:C
Last Name:HOLLIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:JOAN
Other - Middle Name:HOLLIS
Other - Last Name:WINKELMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:103 ALDERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH RUSSELL
Mailing Address - State:OH
Mailing Address - Zip Code:44022-4270
Mailing Address - Country:US
Mailing Address - Phone:440-289-7966
Mailing Address - Fax:440-338-6502
Practice Address - Street 1:103 ALDERWOOD DR
Practice Address - Street 2:
Practice Address - City:SOUTH RUSSELL
Practice Address - State:OH
Practice Address - Zip Code:44022-4270
Practice Address - Country:US
Practice Address - Phone:440-289-7966
Practice Address - Fax:440-338-6502
Is Sole Proprietor?:No
Enumeration Date:2007-11-20
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH031102251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
W14224781Medicare PIN