Provider Demographics
NPI:1801018783
Name:HOLLINGSWORTH, FAITH STIDHAM (PT)
Entity Type:Individual
Prefix:MRS
First Name:FAITH
Middle Name:STIDHAM
Last Name:HOLLINGSWORTH
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 1:209 FITNESS WAY
Mailing Address - Street 2:SUITE D
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35611-2451
Mailing Address - Country:US
Mailing Address - Phone:256-233-9148
Mailing Address - Fax:256-233-9164
Practice Address - Street 1:209 FITNESS WAY
Practice Address - Street 2:SUITE D
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-2451
Practice Address - Country:US
Practice Address - Phone:256-233-9148
Practice Address - Fax:256-233-9164
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH4289225100000X
ALPTH7183225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALPTH4289OtherPHYSICAL THERAPIST LICENS