1942435391 NPI number — JERRY LYNN HOLLANDSWORTH JR. LPTA

Table of content: AMAIRANI ROLON-ESQUIVEL BCBA (NPI 1427632876)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942435391 NPI number — JERRY LYNN HOLLANDSWORTH JR. LPTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLLANDSWORTH
Provider First Name:
JERRY
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
Provider Credential Text:
LPTA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942435391
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/28/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1129 MACKS MOUNTAIN RD NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIAN VALLEY
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24105-3125
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 RANDOLPH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RADFORD
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24141-2430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-633-3708
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/28/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225200000X , with the licence number:  2306601670 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com