Provider Demographics
NPI:1598894982
Name:FENNELL, HOLLY PAIGE
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:PAIGE
Last Name:FENNELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6193 RIDGEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-9777
Mailing Address - Country:US
Mailing Address - Phone:859-647-0304
Mailing Address - Fax:859-647-4052
Practice Address - Street 1:6193 RIDGEWOOD CT
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-9777
Practice Address - Country:US
Practice Address - Phone:859-647-0304
Practice Address - Fax:859-647-4052
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY004186225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist