Provider Demographics
NPI:1245752476
Name:HOLOHAN, CONNOR JOHN
Entity Type:Individual
Prefix:
First Name:CONNOR
Middle Name:JOHN
Last Name:HOLOHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 DETWEILER AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:HELLERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18055-1861
Mailing Address - Country:US
Mailing Address - Phone:570-590-2763
Mailing Address - Fax:
Practice Address - Street 1:831 DETWEILER AVE APT 2
Practice Address - Street 2:
Practice Address - City:HELLERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18055-1861
Practice Address - Country:US
Practice Address - Phone:570-590-2763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer