Provider Demographics
NPI:1356860373
Name:HOLLOWAY, JORDAN L (DPT)
Entity type:Individual
Prefix:MR
First Name:JORDAN
Middle Name:L
Last Name:HOLLOWAY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6397 LEE HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-4915
Mailing Address - Country:US
Mailing Address - Phone:423-238-8930
Mailing Address - Fax:423-254-5217
Practice Address - Street 1:1861 WESTEN ST STE B
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-4151
Practice Address - Country:US
Practice Address - Phone:270-904-2753
Practice Address - Fax:270-904-4680
Is Sole Proprietor?:No
Enumeration Date:2017-09-11
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY007275225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist