Provider Demographics
NPI:1407824915
Name:HOLLENBERG, MICHAEL G (MSPT, CERT MDT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:G
Last Name:HOLLENBERG
Suffix:
Gender:M
Credentials:MSPT, CERT MDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 E EDISON AVE
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:WA
Mailing Address - Zip Code:98944-2204
Mailing Address - Country:US
Mailing Address - Phone:509-837-4455
Mailing Address - Fax:509-837-6299
Practice Address - Street 1:716 E EDISON AVE
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:WA
Practice Address - Zip Code:98944-2204
Practice Address - Country:US
Practice Address - Phone:509-837-4455
Practice Address - Fax:509-837-6299
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00007057225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7106917Medicaid
WA1407824915Medicare NSC