Provider Demographics
NPI:1457798696
Name:HOLLOWAY, GERALD MATTHEW (ATC)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:MATTHEW
Last Name:HOLLOWAY
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 VICTORIA ST
Mailing Address - Street 2:
Mailing Address - City:LUDLOW
Mailing Address - State:KY
Mailing Address - Zip Code:41016-1445
Mailing Address - Country:US
Mailing Address - Phone:859-653-9404
Mailing Address - Fax:
Practice Address - Street 1:427 VICTORIA ST
Practice Address - Street 2:
Practice Address - City:LUDLOW
Practice Address - State:KY
Practice Address - Zip Code:41016-1445
Practice Address - Country:US
Practice Address - Phone:859-653-9404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT6412255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer