Provider Demographics
NPI:1811289051
Name:HOLLINS-HENDERSON, CRYSTAL NICOLE (DPT)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:NICOLE
Last Name:HOLLINS-HENDERSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:NICOLE
Other - Last Name:HOLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2531 ROCKY RIDGE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35243-4415
Mailing Address - Country:US
Mailing Address - Phone:205-978-7376
Mailing Address - Fax:205-978-0861
Practice Address - Street 1:209 FITNESS WAY
Practice Address - Street 2:SUITE D
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-2451
Practice Address - Country:US
Practice Address - Phone:256-233-9148
Practice Address - Fax:256-233-9164
Is Sole Proprietor?:No
Enumeration Date:2011-05-06
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH8275225100000X
TN3362225200000X
TX2081518225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant