Provider Demographics
NPI:1578223970
Name:HOLDERBAUM, STACY (RRT)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:HOLDERBAUM
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:
Other - Last Name:DERRINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 RENAISSANCE DR STE 103
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-7612
Mailing Address - Country:US
Mailing Address - Phone:724-256-9606
Mailing Address - Fax:724-256-9609
Practice Address - Street 1:200 RENAISSANCE DR STE 103
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-7612
Practice Address - Country:US
Practice Address - Phone:724-256-9606
Practice Address - Fax:724-256-9609
Is Sole Proprietor?:No
Enumeration Date:2021-12-27
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATM003293L227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered