1356408744 NPI number — JAMIE MICHELLE HOLLOWAY PT, DPT, PCS

Table of content: MADELINE LAVIGNA (NPI 1053130252)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356408744 NPI number — JAMIE MICHELLE HOLLOWAY PT, DPT, PCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLLOWAY
Provider First Name:
JAMIE
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT, PCS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HALL
Provider Other First Name:
JAMIE
Provider Other Middle Name:
MICHELLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT, DPT, PCS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1356408744
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
999 HARBOR CLUB CIR E APT 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38103-5803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-231-2701
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2965 N GERMANTOWN RD STE 124
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARTLETT
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38133-4055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-683-8787
Provider Business Practice Location Address Fax Number:
901-683-2100
Provider Enumeration Date:
01/03/2007

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: 225100000X , with the licence number:  22725 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 870574 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 222Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 9446 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 891743400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 811859100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".