Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 011563 | GA |
NPI | 1003217316 |
---|---|
Provider Name | Zachary Hollis |
First Address | Orlando, FL 32825-8059 |
Second Address | Lawrenceville, GA 30046-3334 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2014 |
Last Update Date | 06/09/2014 |