Provider Demographics
NPI:1114080645
Name:HOLLAND, WES (CPED)
Entity Type:Individual
Prefix:MR
First Name:WES
Middle Name:
Last Name:HOLLAND
Suffix:
Gender:M
Credentials:CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 STABLEWAY RD
Mailing Address - Street 2:
Mailing Address - City:PIKE ROAD
Mailing Address - State:AL
Mailing Address - Zip Code:36064-2764
Mailing Address - Country:US
Mailing Address - Phone:334-277-1551
Mailing Address - Fax:909-740-2012
Practice Address - Street 1:1758 PARK PL
Practice Address - Street 2:SUITE 300
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-1127
Practice Address - Country:US
Practice Address - Phone:334-538-7696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2588OtherBCP CERTIFICATION NUMBER