Provider Demographics
NPI:1669580841
Name:HOLLIE, KIMBERLY
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:HOLLIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 UNION ST
Mailing Address - Street 2:
Mailing Address - City:LITTLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17340-9197
Mailing Address - Country:US
Mailing Address - Phone:717-359-8037
Mailing Address - Fax:
Practice Address - Street 1:300 W KING ST
Practice Address - Street 2:
Practice Address - City:LITTLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:17340-1446
Practice Address - Country:US
Practice Address - Phone:717-359-4078
Practice Address - Fax:717-345-8233
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
PAPT002856E225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD17469OtherLICENSE#