Provider Demographics
NPI:1568620045
Name:HOLLISTER, MARIA E (PT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:E
Last Name:HOLLISTER
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 1:99 HIGHLAND VIEW DR
Mailing Address - Street 2:
Mailing Address - City:SOMERS
Mailing Address - State:CT
Mailing Address - Zip Code:06071-1557
Mailing Address - Country:US
Mailing Address - Phone:860-749-7795
Mailing Address - Fax:
Practice Address - Street 1:581 POQUONOCK AVE
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-2202
Practice Address - Country:US
Practice Address - Phone:860-688-7211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003605314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility