Provider Demographics
NPI:1982151999
Name:HOLLEY, AUSTIN D (PT, DPT)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:D
Last Name:HOLLEY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6041 GARNERS FERRY RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-1304
Mailing Address - Country:US
Mailing Address - Phone:803-783-0684
Mailing Address - Fax:803-783-1147
Practice Address - Street 1:1519 TAYLOR ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2918
Practice Address - Country:US
Practice Address - Phone:803-779-8327
Practice Address - Fax:803-799-3603
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8348225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8348OtherSC BOARD OF PHYSICAL THERAPY EXAMINERS
SC8348OtherSC BOARD OF PHYSICAL THERAPY EXAMINERS