Provider Demographics
NPI:1316972284
Name:HOLLAND, JENNIFER LEWIS (MPT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LEWIS
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 OAK RIDGE ROAD
Mailing Address - Street 2:SUITE FF
Mailing Address - City:OAK RIDGE
Mailing Address - State:NC
Mailing Address - Zip Code:27310
Mailing Address - Country:US
Mailing Address - Phone:336-644-0201
Mailing Address - Fax:336-644-0501
Practice Address - Street 1:2205 OAK RIDGE RD (OAK RIDGE PHYSICAL THERAPY)
Practice Address - Street 2:SUITE FF
Practice Address - City:OAK RIDGE
Practice Address - State:NC
Practice Address - Zip Code:27310
Practice Address - Country:US
Practice Address - Phone:336-644-0201
Practice Address - Fax:336-644-0501
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8314225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7211321Medicaid
2500658Medicare ID - Type Unspecified