Provider Demographics
NPI:1548306681
Name:HOLWAY, MICHAEL CLARK (PT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CLARK
Last Name:HOLWAY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2031 PRIDE ESTATES RD
Mailing Address - Street 2:
Mailing Address - City:TUSCUMBIA
Mailing Address - State:AL
Mailing Address - Zip Code:35674-6968
Mailing Address - Country:US
Mailing Address - Phone:256-381-2193
Mailing Address - Fax:256-356-2809
Practice Address - Street 1:1404 E AVALON AVE STE B2
Practice Address - Street 2:
Practice Address - City:TUSCUMBIA
Practice Address - State:AL
Practice Address - Zip Code:35674-1771
Practice Address - Country:US
Practice Address - Phone:256-978-4001
Practice Address - Fax:256-978-4002
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH1411225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51506301OtherBLUE CROSS
AL51506301OtherBLUE CROSS