Provider Demographics
NPI:1841826575
Name:HOLLEMAN, JONATHAN MCKEY (PT, DPT)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:MCKEY
Last Name:HOLLEMAN
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 1:4600 GOER DR STE 210
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-6536
Mailing Address - Country:US
Mailing Address - Phone:843-744-5527
Mailing Address - Fax:843-746-9246
Practice Address - Street 1:1797 MAIN RD
Practice Address - Street 2:
Practice Address - City:JOHNS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29455-3447
Practice Address - Country:US
Practice Address - Phone:843-559-7889
Practice Address - Fax:843-559-2355
Is Sole Proprietor?:No
Enumeration Date:2020-03-13
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1013225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC9189OtherPALMETTO GBA