Provider Demographics
NPI:1912274820
Name:HOLLAND, LISSETTE (PT)
Entity Type:Individual
Prefix:MS
First Name:LISSETTE
Middle Name:
Last Name:HOLLAND
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 1:16002 PRESCOTT HILL AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-2923
Mailing Address - Country:US
Mailing Address - Phone:704-942-1476
Mailing Address - Fax:
Practice Address - Street 1:219 MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28134-7528
Practice Address - Country:US
Practice Address - Phone:704-780-4586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-20
Last Update Date:2011-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9691225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist