Provider Demographics
NPI:1417350406
Name:REMMENGA, HOLLY NICHOLE (ATC)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:NICHOLE
Last Name:REMMENGA
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7277
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56321-7277
Mailing Address - Country:US
Mailing Address - Phone:320-363-3140
Mailing Address - Fax:320-363-3141
Practice Address - Street 1:2585 ABBEY ROAD
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:MN
Practice Address - Zip Code:56321
Practice Address - Country:US
Practice Address - Phone:320-363-3140
Practice Address - Fax:320-363-3141
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-03
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN24892255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer