Basic Information
| Provider Information | |||||||||
| NPI: | 1811007529 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOLLANDER | ||||||||
| FirstName: | MARCIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 SE 10TH CT | ||||||||
| Address2: | |||||||||
| City: | DEERFIELD BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334416611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544211838 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2804 N UNIVERSITY DR | ||||||||
| Address2: | |||||||||
| City: | CORAL SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330655010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9542278040 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 225200000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
ID Information
| ID | Type | State | Issuer | Description | PTA19046 | 01 | FL | LICENSE # | OTHER |