Provider Demographics
NPI:1134179088
Name:HOLLOWAY, KRISTEN RENEE (PT)
Entity type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:RENEE
Last Name:HOLLOWAY
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 1:211 BOBBY JONES EXPRESSWAY
Mailing Address - Street 2:SUITE C
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907
Mailing Address - Country:US
Mailing Address - Phone:706-364-5533
Mailing Address - Fax:706-860-8765
Practice Address - Street 1:211 BOBBY JONES EXPRESSWAY
Practice Address - Street 2:SUITE C
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907
Practice Address - Country:US
Practice Address - Phone:706-364-5533
Practice Address - Fax:704-860-8765
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPT 6087225100000X
GAPT009305225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO805124Medicare ID - Type Unspecified