Provider Demographics
NPI:1902131196
Name:SMITH, HOLLY BERRY (MPT)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:BERRY
Last Name:SMITH
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2580 JACKSON AVE W
Mailing Address - Street 2:SUITE 38
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-5489
Mailing Address - Country:US
Mailing Address - Phone:662-232-8949
Mailing Address - Fax:662-232-8950
Practice Address - Street 1:2580 JACKSON AVE W
Practice Address - Street 2:SUITE 38
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5489
Practice Address - Country:US
Practice Address - Phone:662-232-8949
Practice Address - Fax:662-232-8950
Is Sole Proprietor?:No
Enumeration Date:2009-10-06
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT3820225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist