Provider Demographics
NPI:1194707141
Name:HOLLOWELL, LEIGH CURTIS (PT)
Entity type:Individual
Prefix:
First Name:LEIGH
Middle Name:CURTIS
Last Name:HOLLOWELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LEIGH
Other - Middle Name:CURTIS
Other - Last Name:HOLLOWGRASS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3300 WEBSTER ST
Mailing Address - Street 2:SUITE 402
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3117
Mailing Address - Country:US
Mailing Address - Phone:510-451-6020
Mailing Address - Fax:510-451-6733
Practice Address - Street 1:3300 WEBSTER ST
Practice Address - Street 2:SUITE 402
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3117
Practice Address - Country:US
Practice Address - Phone:510-451-6020
Practice Address - Fax:510-451-6733
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT17492225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OPT174920Medicare ID - Type UnspecifiedPPIN
P87493Medicare UPIN