Provider Demographics
NPI:1982835013
Name:HOLLIFIELD, KATHERN SUE (RPT)
Entity Type:Individual
Prefix:MS
First Name:KATHERN
Middle Name:SUE
Last Name:HOLLIFIELD
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:K.
Other - Middle Name:
Other - Last Name:HOLLIFIELD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:275 O. SIMMONS RD
Mailing Address - Street 2:
Mailing Address - City:DERIDDER
Mailing Address - State:LA
Mailing Address - Zip Code:70634
Mailing Address - Country:US
Mailing Address - Phone:337-462-0964
Mailing Address - Fax:337-462-0171
Practice Address - Street 1:309 S. WASHINGTON ST.
Practice Address - Street 2:BEAUREGARD PHYSICAL THERAPY CLINIC INC
Practice Address - City:DERIDDER
Practice Address - State:LA
Practice Address - Zip Code:70634
Practice Address - Country:US
Practice Address - Phone:337-462-6097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA00364R225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist