Provider Demographics
NPI:1497369565
Name:HOLLINGER, REGINALD DWANE
Entity Type:Individual
Prefix:MR
First Name:REGINALD
Middle Name:DWANE
Last Name:HOLLINGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 DILIDO RD APT 1132
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75228-5176
Mailing Address - Country:US
Mailing Address - Phone:407-404-3994
Mailing Address - Fax:
Practice Address - Street 1:8502 EDGEMERE RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-3523
Practice Address - Country:US
Practice Address - Phone:214-615-7045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2160455225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant