Provider Demographics
NPI:1659504710
Name:HOLLINS, SHANI MARIE (MSPT)
Entity Type:Individual
Prefix:
First Name:SHANI
Middle Name:MARIE
Last Name:HOLLINS
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:376 GOSHEN RD
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-2722
Mailing Address - Country:US
Mailing Address - Phone:860-618-0416
Mailing Address - Fax:860-618-0417
Practice Address - Street 1:376 GOSHEN RD
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-2722
Practice Address - Country:US
Practice Address - Phone:860-618-0416
Practice Address - Fax:860-618-0417
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-24
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007977225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist