Provider Demographics
NPI:1407934466
Name:HOLLAND, MARY B (PT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:B
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:21525 HWY 410 E
Mailing Address - Street 2:SUITE B
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391-4101
Mailing Address - Country:US
Mailing Address - Phone:253-826-8520
Mailing Address - Fax:253-826-8522
Practice Address - Street 1:2726 GRIFIN AVE
Practice Address - Street 2:STE C
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022
Practice Address - Country:US
Practice Address - Phone:360-802-6757
Practice Address - Fax:360-802-6756
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2009-05-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAPT3280225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist