Provider Demographics
NPI:1689684854
Name:HOLLAND, JASON C (MPT)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:C
Last Name:HOLLAND
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 W 26TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-1469
Mailing Address - Country:US
Mailing Address - Phone:814-452-4447
Mailing Address - Fax:814-452-4437
Practice Address - Street 1:1325 W 26TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-1469
Practice Address - Country:US
Practice Address - Phone:814-452-4447
Practice Address - Fax:814-452-4437
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT009703L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA081189Medicare ID - Type UnspecifiedMEDICARE
PAQ20088Medicare UPIN