Provider Demographics
NPI:1619096831
Name:HOLLINGSWORTH, ANNALISA MARTINEZ (LPT)
Entity Type:Individual
Prefix:
First Name:ANNALISA
Middle Name:MARTINEZ
Last Name:HOLLINGSWORTH
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5505 SOUTH EXPRESSWAY 77 83
Mailing Address - Street 2:STE 303
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550
Mailing Address - Country:US
Mailing Address - Phone:956-425-9425
Mailing Address - Fax:956-425-7339
Practice Address - Street 1:5505 SOUTH EXPRESSWAY 77 83
Practice Address - Street 2:STE 303
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550
Practice Address - Country:US
Practice Address - Phone:956-425-9425
Practice Address - Fax:956-425-7339
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1068013225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1068013OtherLICENSE #