Provider Demographics
NPI:1881762664
Name:WILSON, HOLLY L (PT)
Entity type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:L
Last Name:WILSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4546 S 14TH ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-4737
Mailing Address - Country:US
Mailing Address - Phone:325-795-9675
Mailing Address - Fax:325-795-9680
Practice Address - Street 1:4546 S 14TH ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605-4737
Practice Address - Country:US
Practice Address - Phone:325-795-9675
Practice Address - Fax:325-795-9680
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1159817225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist