Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 6271 | TN |
NPI | 1013453513 |
---|---|
Provider Name | Danielle Nicole Holloway |
First Address | Knoxville, TN 37917-5550 |
Second Address | Knoxville, TN 37917 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2017 |
Last Update Date | 09/01/2017 |