Provider Demographics
NPI:1184726812
Name:PELLA, HOLLY ANN (ATC)
Entity type:Individual
Prefix:MISS
First Name:HOLLY
Middle Name:ANN
Last Name:PELLA
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 S DICKERSON RD
Mailing Address - Street 2:#138
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-1700
Mailing Address - Country:US
Mailing Address - Phone:615-851-0287
Mailing Address - Fax:
Practice Address - Street 1:409 NORTHCREST DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:TN
Practice Address - Zip Code:37172-3973
Practice Address - Country:US
Practice Address - Phone:615-382-3078
Practice Address - Fax:615-382-2638
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7642255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer