Provider Demographics
NPI:1275149411
Name:MCHALE, HOLLY CHRISTINE (ATC)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:CHRISTINE
Last Name:MCHALE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:CHRISTINE
Other - Last Name:MENDENHALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ATC
Mailing Address - Street 1:2417 JERICHO TPKE # 268
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-4710
Mailing Address - Country:US
Mailing Address - Phone:631-662-6355
Mailing Address - Fax:
Practice Address - Street 1:350 S SERVICE RD
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-3233
Practice Address - Country:US
Practice Address - Phone:631-662-6355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0030782255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer