Provider Demographics
NPI:1861891277
Name:GILL, HOLLY E (DPT)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:E
Last Name:GILL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3451 PINE RIDGE RD BLDG 601
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-3922
Mailing Address - Country:US
Mailing Address - Phone:394-493-0722
Mailing Address - Fax:877-334-1886
Practice Address - Street 1:7273 VANDERBILT BEACH RD STE 33
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-1479
Practice Address - Country:US
Practice Address - Phone:239-312-7878
Practice Address - Fax:866-914-4440
Is Sole Proprietor?:No
Enumeration Date:2014-08-21
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11967225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100095457Medicaid