Basic Information
| Provider Information | |||||||||
| NPI: | 1811289051 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOLLINS-HENDERSON | ||||||||
| FirstName: | CRYSTAL | ||||||||
| MiddleName: | NICOLE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | DPT | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | HOLLINS | ||||||||
| OtherFirstName: | CRYSTAL | ||||||||
| OtherMiddleName: | NICOLE | ||||||||
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| OtherCredential: | DPT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2531 ROCKY RIDGE RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | VESTAVIA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352434415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059787376 | ||||||||
| FaxNumber: | 2059780861 | ||||||||
| Practice Location | |||||||||
| Address1: | 209 FITNESS WAY | ||||||||
| Address2: | SUITE D | ||||||||
| City: | ATHENS | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356112451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2562339148 | ||||||||
| FaxNumber: | 2562339164 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2011 | ||||||||
| LastUpdateDate: | 03/31/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PTH8275 | AL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225200000X | 3362 | TN | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | 225200000X | 2081518 | TX | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.