Provider Demographics
NPI:1629485610
Name:HOLLAND, SARA
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:MUTOLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:8 CENTURY HILL DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2193
Mailing Address - Country:US
Mailing Address - Phone:518-690-4406
Mailing Address - Fax:518-220-9220
Practice Address - Street 1:8 CENTURY HILL DR
Practice Address - Street 2:SUITE 201
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2193
Practice Address - Country:US
Practice Address - Phone:518-690-4406
Practice Address - Fax:518-220-9220
Is Sole Proprietor?:No
Enumeration Date:2014-07-22
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032984225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist