Provider Demographics
NPI:1811625775
Name:HOLLOWAY, DEMIK (PT, DPT)
Entity type:Individual
Prefix:
First Name:DEMIK
Middle Name:
Last Name:HOLLOWAY
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8201 ATLEE RD STE D
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-1815
Mailing Address - Country:US
Mailing Address - Phone:804-716-0457
Mailing Address - Fax:804-716-0496
Practice Address - Street 1:4101 COX RD STE 360
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-3320
Practice Address - Country:US
Practice Address - Phone:804-716-0457
Practice Address - Fax:804-716-0496
Is Sole Proprietor?:No
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA2305215255225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist