Basic Information
Provider Information
NPI: 1306224167
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CASSIDY
FirstName: HOLLY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: DPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 681478
Address2:  
City: FRANKLIN
State: TN
PostalCode: 370681478
CountryCode: US
TelephoneNumber: 6155916590
FaxNumber: 6155916601
Practice Location
Address1: 119 SEABOARD LN
Address2:  
City: FRANKLIN
State: TN
PostalCode: 37067
CountryCode: US
TelephoneNumber: 6157789894
FaxNumber: 6157789843
Other Information
ProviderEnumerationDate: 05/13/2015
LastUpdateDate: 06/30/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/30/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X TNN Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 
225100000X10424TNY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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