Provider Demographics
NPI:1740380740
Name:HOLLIE, MONICA MOSELEY (PT)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:MOSELEY
Last Name:HOLLIE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11635 HARBOR EAST DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76179-9453
Mailing Address - Country:US
Mailing Address - Phone:817-713-8485
Mailing Address - Fax:
Practice Address - Street 1:1100 N BLUE MOUND RD
Practice Address - Street 2:SUITE 130
Practice Address - City:SAGINAW
Practice Address - State:TX
Practice Address - Zip Code:76131-4901
Practice Address - Country:US
Practice Address - Phone:817-232-3553
Practice Address - Fax:817-232-7882
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1153129225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1740380740OtherCOMMERCIAL INSURANCE