Provider Demographics
NPI:1881810646
Name:HOLLINGSWORTH, KENNETH DANIEL (PT)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:DANIEL
Last Name:HOLLINGSWORTH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 WESTERLY DR
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-3031
Mailing Address - Country:US
Mailing Address - Phone:856-404-9262
Mailing Address - Fax:
Practice Address - Street 1:550 JESSUP RD
Practice Address - Street 2:
Practice Address - City:PAULSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08066-1921
Practice Address - Country:US
Practice Address - Phone:856-848-9551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01128000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist