Basic Information
| Provider Information | |||||||||
| NPI: | 1154379402 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WEXLER | ||||||||
| FirstName: | HOLLY | ||||||||
| MiddleName: | BETH | ||||||||
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| Credential: | MPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 126 S STATE ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | NEWTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189403524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2155796991 | ||||||||
| FaxNumber: | 2155799774 | ||||||||
| Practice Location | |||||||||
| Address1: | 126 S STATE ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | NEWTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189403524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2155796991 | ||||||||
| FaxNumber: | 2155799774 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT-0008212-L | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | HIGHMARK BC/BS | 01 | PA | 907969 | OTHER | INDEPENDENCE BC | 01 | PA | 0349709000 | OTHER |