Provider Demographics
NPI:1679395271
Name:HOLLIE, RICKY ALLEN (PTA)
Entity type:Individual
Prefix:
First Name:RICKY
Middle Name:ALLEN
Last Name:HOLLIE
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 HOLBROOK ST STE 202
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-1759
Mailing Address - Country:US
Mailing Address - Phone:434-799-2382
Mailing Address - Fax:
Practice Address - Street 1:101 HOLBROOK ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-1759
Practice Address - Country:US
Practice Address - Phone:434-799-2382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-26
Last Update Date:2024-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306001480225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty