Provider Demographics
NPI:1962745000
Name:HOLLIDAY, JAY WILLIAM (RKT)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:WILLIAM
Last Name:HOLLIDAY
Suffix:
Gender:M
Credentials:RKT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3707 LOOP RD.
Mailing Address - Street 2:TUSCALOOSA VA MEDICAL CENTER
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35404
Mailing Address - Country:US
Mailing Address - Phone:205-554-2822
Mailing Address - Fax:205-554-2894
Practice Address - Street 1:3707 LOOP RD.
Practice Address - Street 2:TUSCALOOSA VA MEDICAL CENTER
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404
Practice Address - Country:US
Practice Address - Phone:205-554-2822
Practice Address - Fax:205-554-2894
Is Sole Proprietor?:No
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1689226300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist