Provider Demographics
NPI:1598415325
Name:HOLLAND, JEAN (PT, DPT, MS)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:PT, DPT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4922 BROOKSIDE CT
Mailing Address - Street 2:
Mailing Address - City:COOPERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18036-8729
Mailing Address - Country:US
Mailing Address - Phone:610-442-7486
Mailing Address - Fax:
Practice Address - Street 1:1534 PARK AVE STE 110
Practice Address - Street 2:
Practice Address - City:QUAKERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18951-1085
Practice Address - Country:US
Practice Address - Phone:267-424-8750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-25
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02071800225100000X
PAPT030318225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist