Provider Demographics
NPI:1861614836
Name:HOLLY, ARLETTA CHERISE (MASTER OF PT)
Entity type:Individual
Prefix:
First Name:ARLETTA
Middle Name:CHERISE
Last Name:HOLLY
Suffix:
Gender:F
Credentials:MASTER OF PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 CHURCH LN STE 126
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-3786
Mailing Address - Country:US
Mailing Address - Phone:410-484-6127
Mailing Address - Fax:410-484-6024
Practice Address - Street 1:104 CHURCH LN STE 126
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-3786
Practice Address - Country:US
Practice Address - Phone:410-484-6127
Practice Address - Fax:410-484-6024
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20692225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD20692OtherMD BOARD OF PT