Provider Demographics
NPI:1164872255
Name:HOLLENBACK, OLIVIA ANN (DPT)
Entity Type:Individual
Prefix:MS
First Name:OLIVIA
Middle Name:ANN
Last Name:HOLLENBACK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:OLIVIA
Other - Middle Name:ANN
Other - Last Name:PRYZBYLKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:570-837-2185
Practice Address - Street 1:170 N POINTE BLVD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4132
Practice Address - Country:US
Practice Address - Phone:717-299-4871
Practice Address - Fax:717-391-2494
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-20
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT025467225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1031205060005Medicaid
PA796557OtherMEDICARE
PA1031205060006Medicaid