SAMUEL HOLLAND (PT, DPT) – Physical Therapist, NPI 1104649250

SAMUEL HOLLAND (PT, DPT) is a healthcare provider. based in Russellville, Arkansas. specializing in PHYSICAL THERAPIST IN PRIVATE PRACTICE. They hold the professional credentials PT, DPT. They hold a License No. PT5579 (AR). The NPI Number for SAMUEL HOLLAND (PT, DPT) is 1104649250

Main info

Male
Sole Proprietor
2 Years Of Experience
Accepts Medicare Assignment
Name
SAMUEL HOLLAND (PT, DPT)
NPI
1104649250
Phone
(479) 968-2525
Address
2100 W MAIN ST
Enumeration Date
6 November 2024
Last Update Date
14 July 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
4799682525
Graduation Year
2024 (2 years ago)
PAC ID
1658809579
Group Practice PAC ID
1850294018
Professional Enrollment ID
I20250106002820
Address ID
AR728012758RU2100XSTXX400
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience26
Completeness85
Years active:1State licenses:1Digital endpointsOther names

835 PHYSICAL THERAPIST IN PRIVATE PRACTICE in AR

Provider Addresses for SAMUEL HOLLAND (PT, DPT)

  • 2100 W MAIN ST

    RUSSELLVILLE, AR 728012758

    Phone: (479) 968-2525

    Fax: (479) 968-2539

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2025-01-06

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20250106002820IPhysical Therapist In Private PracticeARTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 72801)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 1850294018View full group profile
NameSpecialtyState
-AR
Physical Therapist In Private PracticeAR
Physical Therapist In Private PracticeAR
-AR
Physical Therapist In Private PracticeAR
Physical Therapist In Private PracticeAR
Physical Therapist In Private PracticeAR
Physical Therapist In Private PracticeAR
Physical Therapist In Private PracticeAR
Physical Therapist In Private PracticeAR

Reviews

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Frequently asked questions

Can I cross-check SAMUEL HOLLAND (PT, DPT) using NPI 1104649250?
NPI 1104649250 belongs to SAMUEL HOLLAND (PT, DPT); compare other details if you need extra assurance.
Is SAMUEL HOLLAND (PT, DPT) still an active registrant?
SAMUEL HOLLAND (PT, DPT) carries an active NPI according to the public dataset.
How would a patient describe SAMUEL HOLLAND (PT, DPT)'s focus?
For SAMUEL HOLLAND (PT, DPT), the primary taxonomy reads as Physical Therapist. Clinical services aligned with this taxonomy classification.
Where in Arkansas is SAMUEL HOLLAND (PT, DPT) registered?
Use Russellville, Arkansas as the headline location for SAMUEL HOLLAND (PT, DPT) here.
Can I trust this NPI listing for SAMUEL HOLLAND (PT, DPT)?
The listing is sourced from the national NPI registry. If something looks off, compare with NPPES and the clinic's website.

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