Provider Demographics
NPI:1093885493
Name:BOLAND, DENISE MARIE (P T ASSISTANT)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:MARIE
Last Name:BOLAND
Suffix:
Gender:F
Credentials:P T ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3976 HUMPHREY RD
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44286-9541
Mailing Address - Country:US
Mailing Address - Phone:330-659-9329
Mailing Address - Fax:
Practice Address - Street 1:5232 BROADVIEW RD
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:OH
Practice Address - Zip Code:44286-9481
Practice Address - Country:US
Practice Address - Phone:330-659-4161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA, 02160225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant