Provider Demographics
NPI:1750566691
Name:PRENTICE, HOLLY A (PT)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:A
Last Name:PRENTICE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:A
Other - Last Name:SLONIEWSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18220 STATE HIGHWAY 249 STE 330
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-4349
Mailing Address - Country:US
Mailing Address - Phone:281-807-4380
Mailing Address - Fax:281-501-5999
Practice Address - Street 1:18220 STATE HIGHWAY 249 STE 330
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4349
Practice Address - Country:US
Practice Address - Phone:281-807-4380
Practice Address - Fax:281-501-5999
Is Sole Proprietor?:No
Enumeration Date:2008-01-09
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17584225100000X
TX1185348225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC8K4938Medicare PIN