Provider Demographics
NPI:1255420626
Name:HOLLENBECK, CAROL S (PT)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:S
Last Name:HOLLENBECK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:H
Other - Last Name:GLASSCOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:575 75TH AVE
Mailing Address - Street 2:
Mailing Address - City:ST PETE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33706-1833
Mailing Address - Country:US
Mailing Address - Phone:727-367-0075
Mailing Address - Fax:727-367-0402
Practice Address - Street 1:575 75TH AVE
Practice Address - Street 2:
Practice Address - City:ST PETE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33706-1833
Practice Address - Country:US
Practice Address - Phone:727-367-0075
Practice Address - Fax:727-367-0402
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2012-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT#00085752251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU0978Medicare ID - Type UnspecifiedMEDICARE PROVIDER #