Provider Demographics
NPI:1356408744
Name:HOLLOWAY, JAMIE MICHELLE (PT, DPT, PCS)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:MICHELLE
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:PT, DPT, PCS
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:MICHELLE
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT, PCS
Mailing Address - Street 1:999 HARBOR CLUB CIR E APT 201
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-5803
Mailing Address - Country:US
Mailing Address - Phone:703-231-2701
Mailing Address - Fax:
Practice Address - Street 1:2965 N GERMANTOWN RD STE 124
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38133-4055
Practice Address - Country:US
Practice Address - Phone:901-683-8787
Practice Address - Fax:901-683-2100
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22725225100000X
DC870574225100000X
222Q00000X
TN9446225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL891743400Medicaid
FL811859100Medicaid