Provider Demographics
NPI:1497090401
Name:KNOWLES, HOLLY LANE (PTA)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:LANE
Last Name:KNOWLES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:371 CORAL AVE
Mailing Address - Street 2:
Mailing Address - City:RAMROD KEY
Mailing Address - State:FL
Mailing Address - Zip Code:33042-5323
Mailing Address - Country:US
Mailing Address - Phone:850-419-4191
Mailing Address - Fax:
Practice Address - Street 1:371 CORAL AVE
Practice Address - Street 2:
Practice Address - City:RAMROD KEY
Practice Address - State:FL
Practice Address - Zip Code:33042-5323
Practice Address - Country:US
Practice Address - Phone:850-419-4191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-02
Last Update Date:2012-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 22614225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant