Provider Demographics
NPI:1184394488
Name:HOLLIDAY, LAUREN ELISABETH (DPT)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:ELISABETH
Last Name:HOLLIDAY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:LAUREN
Other - Middle Name:ELISABETH
Other - Last Name:PAGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:318 PLOTT FARM CIR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28716-6300
Mailing Address - Country:US
Mailing Address - Phone:919-495-0369
Mailing Address - Fax:
Practice Address - Street 1:262 LEROY GEORGE DR
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721-7430
Practice Address - Country:US
Practice Address - Phone:828-452-8071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP16506225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist