Provider Demographics
NPI:1487702247
Name:WEBSTER, HOLLY PAIGE
Entity type:Individual
Prefix:MISS
First Name:HOLLY
Middle Name:PAIGE
Last Name:WEBSTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23319 CR 2116
Mailing Address - Street 2:
Mailing Address - City:TROUP
Mailing Address - State:TX
Mailing Address - Zip Code:75789-5716
Mailing Address - Country:US
Mailing Address - Phone:256-626-8337
Mailing Address - Fax:
Practice Address - Street 1:1401 RICE RD
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-3233
Practice Address - Country:US
Practice Address - Phone:903-561-6060
Practice Address - Fax:256-832-2004
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2023-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2074103225200000X
ALPTA4605225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant