Provider Demographics
NPI:1124882915
Name:HAGOOD, HOLLY (DPT)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:HAGOOD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:HAGOOD
Other - Last Name:KEYES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9504 GEORGE WILLIAMS RD APT SUITE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-4211
Mailing Address - Country:US
Mailing Address - Phone:865-385-1174
Mailing Address - Fax:
Practice Address - Street 1:1690 ROSE MOSS CT SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-3969
Practice Address - Country:US
Practice Address - Phone:301-275-4057
Practice Address - Fax:423-702-4493
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0169972251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics