Provider Demographics
NPI:1497301592
Name:CLECKLER, HOLLY (PT)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:CLECKLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 SW 148TH AVE STE 115
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4181
Mailing Address - Country:US
Mailing Address - Phone:954-438-7000
Mailing Address - Fax:954-589-1742
Practice Address - Street 1:3000 SW 148TH AVE STE 115
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-4181
Practice Address - Country:US
Practice Address - Phone:954-438-7000
Practice Address - Fax:954-589-1742
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty