Provider Demographics
NPI:1770552515
Name:MASSENGILL, HOLLY (PT)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:MASSENGILL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14154 NICHOLAS DR
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-9096
Mailing Address - Country:US
Mailing Address - Phone:317-566-1858
Mailing Address - Fax:317-566-1920
Practice Address - Street 1:845 W CARMEL DR
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-5804
Practice Address - Country:US
Practice Address - Phone:317-566-1858
Practice Address - Fax:317-566-1920
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05006706A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist