Provider Demographics
NPI:1366075855
Name:KING, HOLLY (MA, LAT, ATC, CPT)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:MA, LAT, ATC, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10407 US HIGHWAY 31 APT 115
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORT
Mailing Address - State:AL
Mailing Address - Zip Code:36527-7619
Mailing Address - Country:US
Mailing Address - Phone:850-226-2331
Mailing Address - Fax:
Practice Address - Street 1:1500 E JOHNSON AVE APT 228
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-4671
Practice Address - Country:US
Practice Address - Phone:850-226-2331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-13
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program