Provider Demographics
NPI:1851855712
Name:HOLLAWAY, ELAINE LOUISE (PT)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:LOUISE
Last Name:HOLLAWAY
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 1:555 MT LOGAN DR SW
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-4023
Mailing Address - Country:US
Mailing Address - Phone:425-890-4602
Mailing Address - Fax:
Practice Address - Street 1:2424 156TH AVE NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-3814
Practice Address - Country:US
Practice Address - Phone:425-890-4602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00007842225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist