Provider Demographics
NPI:1528412525
Name:HOLLIGAN, ALEC
Entity Type:Individual
Prefix:MR
First Name:ALEC
Middle Name:
Last Name:HOLLIGAN
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 1:7925 BRENT LEAF AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-5003
Mailing Address - Country:US
Mailing Address - Phone:702-400-5050
Mailing Address - Fax:
Practice Address - Street 1:7465 W LAKE MEAD BLVD STE 119
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-1032
Practice Address - Country:US
Practice Address - Phone:702-562-8137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-16
Last Update Date:2016-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner