Provider Demographics
NPI:1831766716
Name:HOLLANDSWORTH, BRIANNE (PT, DPT)
Entity type:Individual
Prefix:
First Name:BRIANNE
Middle Name:
Last Name:HOLLANDSWORTH
Suffix:
Gender:F
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 1:3523 SAN JOSE LN
Mailing Address - Street 2:
Mailing Address - City:SAINT ANN
Mailing Address - State:MO
Mailing Address - Zip Code:63074-2806
Mailing Address - Country:US
Mailing Address - Phone:314-308-8100
Mailing Address - Fax:
Practice Address - Street 1:1001 S KIRKWOOD RD STE 150
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-7251
Practice Address - Country:US
Practice Address - Phone:314-821-7557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2024-07-17
Deactivation Date:2024-06-14
Deactivation Code:
Reactivation Date:2024-07-17
Provider Licenses
StateLicense IDTaxonomies
MO2021019126225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist