Provider Demographics
NPI:1952715732
Name:HOLLOWAY, JARED
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:HOLLOWAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6444 KATHY DR
Mailing Address - Street 2:
Mailing Address - City:PINSON
Mailing Address - State:AL
Mailing Address - Zip Code:35126-3114
Mailing Address - Country:US
Mailing Address - Phone:205-516-5973
Mailing Address - Fax:
Practice Address - Street 1:7272 GADSDEN HWY
Practice Address - Street 2:SUITE 108
Practice Address - City:TRUSSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35173-1687
Practice Address - Country:US
Practice Address - Phone:205-655-7231
Practice Address - Fax:205-655-7232
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-19
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7502255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer