Provider Demographics
NPI:1891942140
Name:MARIN, HOLLY (LPT)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:MARIN
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:
Other - Last Name:RAPPLEYE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPT
Mailing Address - Street 1:5445 PRESTON OAKS RD
Mailing Address - Street 2:1425
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-2418
Mailing Address - Country:US
Mailing Address - Phone:817-501-6116
Mailing Address - Fax:214-758-0201
Practice Address - Street 1:5445 PRESTON OAKS RD
Practice Address - Street 2:1425
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-2418
Practice Address - Country:US
Practice Address - Phone:817-501-6116
Practice Address - Fax:214-758-0201
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1183233225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165348701Medicaid
TX456643Medicare PIN