Provider Demographics
NPI:1043484900
Name:THE HOLLOWAY REHABILITATION AND PAIN CENTER INC
Entity type:Organization
Organization Name:THE HOLLOWAY REHABILITATION AND PAIN CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-598-9696
Mailing Address - Street 1:12245 SW 112TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4830
Mailing Address - Country:US
Mailing Address - Phone:305-598-9696
Mailing Address - Fax:305-598-4479
Practice Address - Street 1:12245 SW 112TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4830
Practice Address - Country:US
Practice Address - Phone:305-598-9696
Practice Address - Fax:305-598-4479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT0001638225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL891154100Medicaid
FL106710Medicare Oscar/Certification