Provider Demographics
NPI:1639364391
Name:HOLIDAY PARK PHYSICAL REHABILITATION
Entity Type:Organization
Organization Name:HOLIDAY PARK PHYSICAL REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING CLERK
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:DUNNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-873-3488
Mailing Address - Street 1:27511 HOLIDAY LN
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-5315
Mailing Address - Country:US
Mailing Address - Phone:419-873-3488
Mailing Address - Fax:
Practice Address - Street 1:27511 HOLIDAY LN
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-5315
Practice Address - Country:US
Practice Address - Phone:419-873-3488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty