Provider Demographics
NPI:1053635219
Name:MANDZIARA, HOLLY EVE (PT)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:EVE
Last Name:MANDZIARA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:EVE
Other - Last Name:MRAZEK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:9253 BARBERRY LN
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-4206
Mailing Address - Country:US
Mailing Address - Phone:847-297-2461
Mailing Address - Fax:
Practice Address - Street 1:9253 BARBERRY LN
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-4206
Practice Address - Country:US
Practice Address - Phone:847-297-2461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.011041225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic