Provider Demographics
NPI:1881999233
Name:HOLLOWAY, ANGELA CHRISTINE (MPT)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:CHRISTINE
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:CHRISTINE
Other - Last Name:GAUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:2532 LEMAY FERRY RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63125-3131
Mailing Address - Country:US
Mailing Address - Phone:314-845-0068
Mailing Address - Fax:
Practice Address - Street 1:2532 LEMAY FERRY RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63125-3131
Practice Address - Country:US
Practice Address - Phone:314-845-0068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-17
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010041502225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist