Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | PT#0008575 | FL |
NPI | 1255420626 |
---|---|
Provider Name | Carol S Hollenbeck |
First Address | St Pete Beach, FL 33706-1833 |
Second Address | St Pete Beach, FL 33706-1833 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 01/12/2012 |