Provider Demographics
NPI:1043903834
Name:HOLLAND, KRISHA ANDREA (DPT)
Entity type:Individual
Prefix:
First Name:KRISHA
Middle Name:ANDREA
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KRISHA
Other - Middle Name:ANDREA
Other - Last Name:AYTONA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2122 AIRLINE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-3270
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:670 ALBEMARLE DR STE 1100
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-5947
Practice Address - Country:US
Practice Address - Phone:318-828-1450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10903225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist