Provider Demographics
NPI:1376746917
Name:HOLTZMAN, LAUREN SUE (PT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:SUE
Last Name:HOLTZMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 FREDERICK RD REAR
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4516
Mailing Address - Country:US
Mailing Address - Phone:410-744-2800
Mailing Address - Fax:410-313-8622
Practice Address - Street 1:924 FREDERICK RD REAR
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-4516
Practice Address - Country:US
Practice Address - Phone:410-744-2800
Practice Address - Fax:410-313-8622
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15282225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDT104OtherGHMI
MDJ315LSOtherCARE FIRST
MDJ315LSOtherCARE FIRST