Basic Information
| Provider Information | |||||||||
| NPI: | 1235736885 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOLLERAN | ||||||||
| FirstName: | DAVID | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 655 NORTHERN BLVD | ||||||||
| Address2: | |||||||||
| City: | SOUTH ABINGTON TOWNSHIP | ||||||||
| State: | PA | ||||||||
| PostalCode: | 184118740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5708429323 | ||||||||
| FaxNumber: | 5708429362 | ||||||||
| Practice Location | |||||||||
| Address1: | 116 WALNUT ST | ||||||||
| Address2: | |||||||||
| City: | ATHENS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 188101735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5708880057 | ||||||||
| FaxNumber: | 5708880058 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2020 | ||||||||
| LastUpdateDate: | 10/07/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT028946 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | PT028946 | 01 | PA | DEPARTMENT OF STATE | OTHER |