Provider Demographics
NPI:1841968526
Name:BUI, HOLLY CONNOR (PTA, AS, BS)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:CONNOR
Last Name:BUI
Suffix:
Gender:F
Credentials:PTA, AS, BS
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:LAUREN
Other - Last Name:CONNOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3001 SCOFIELD RIDGE PKWY APT 5110
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78727-6554
Mailing Address - Country:US
Mailing Address - Phone:832-764-6633
Mailing Address - Fax:
Practice Address - Street 1:4100 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-6056
Practice Address - Country:US
Practice Address - Phone:512-454-4711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2162215225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant