Provider Demographics
NPI:1578600169
Name:HOLLIER, CHARLES E (PT)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:E
Last Name:HOLLIER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:40497 BLACK BAYOU EXT
Mailing Address - Street 2:SUITE A
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737
Mailing Address - Country:US
Mailing Address - Phone:225-644-0390
Mailing Address - Fax:225-644-8283
Practice Address - Street 1:40497 BLACK BAYOU EXT
Practice Address - Street 2:SUITE A
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737
Practice Address - Country:US
Practice Address - Phone:225-644-0390
Practice Address - Fax:225-644-8283
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA02889R225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA68 0567729OtherTAX ID
LA68 0567729OtherTAX ID