Provider Demographics
NPI:1013456441
Name:FAUNCE, HOLLY (DPT)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:FAUNCE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:
Other - Last Name:HARDING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:105 MARINER HEALTH WAY
Mailing Address - Street 2:SUITE 213
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-3251
Mailing Address - Country:US
Mailing Address - Phone:904-217-4259
Mailing Address - Fax:904-217-4251
Practice Address - Street 1:105 MARINER HEALTH WAY
Practice Address - Street 2:SUITE 213
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-3251
Practice Address - Country:US
Practice Address - Phone:904-217-4259
Practice Address - Fax:904-217-4251
Is Sole Proprietor?:No
Enumeration Date:2017-02-17
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT32330225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P01864495OtherRAILROAD MEDICARE