Provider Demographics
NPI:1134334659
Name:BROOKSHIRE, HOLLIE ELIZABETH (PTA, DT)
Entity type:Individual
Prefix:MRS
First Name:HOLLIE
Middle Name:ELIZABETH
Last Name:BROOKSHIRE
Suffix:
Gender:F
Credentials:PTA, DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 DUFFY RD
Mailing Address - Street 2:
Mailing Address - City:BOAZ
Mailing Address - State:KY
Mailing Address - Zip Code:42027-8467
Mailing Address - Country:US
Mailing Address - Phone:270-658-3221
Mailing Address - Fax:
Practice Address - Street 1:235 DUFFY RD
Practice Address - Street 2:
Practice Address - City:BOAZ
Practice Address - State:KY
Practice Address - Zip Code:42027-8467
Practice Address - Country:US
Practice Address - Phone:270-658-3221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
KYPTA-A01168225200000X
IL225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Not Answered225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant