Basic Information
| Provider Information | |||||||||
| NPI: | 1255945473 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOLLINGSWORTH | ||||||||
| FirstName: | BROOKE | ||||||||
| MiddleName: | ANN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1800 SE MOBERLY LN STE 6 | ||||||||
| Address2: | |||||||||
| City: | BENTONVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727127017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4797156330 | ||||||||
| FaxNumber: | 4792685144 | ||||||||
| Practice Location | |||||||||
| Address1: | 1800 SE MOBERLY LN STE 6 | ||||||||
| Address2: | |||||||||
| City: | BENTONVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727127017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4797156330 | ||||||||
| FaxNumber: | 4792685144 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/04/2020 | ||||||||
| LastUpdateDate: | 04/15/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2081S0010X | 1338031 | TX | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Sports Medicine | 225100000X | PT4884 | AR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.