Provider Demographics
NPI:1124202809
Name:HOLLANDSWORTH, RENEE CAPRICE (DPT)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:CAPRICE
Last Name:HOLLANDSWORTH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1067 N LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-5843
Mailing Address - Country:US
Mailing Address - Phone:714-532-3493
Mailing Address - Fax:
Practice Address - Street 1:23293 S POINTE DR
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1447
Practice Address - Country:US
Practice Address - Phone:949-770-5843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34213225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist