Provider Demographics
NPI:1760468060
Name:KANTOR, HOLLY ANN (PT)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:ANN
Last Name:KANTOR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:DR
Other - First Name:JAMES
Other - Middle Name:DOUGLAS
Other - Last Name:KANTOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1 CREDIT UNION WAY FL 3
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-4633
Mailing Address - Country:US
Mailing Address - Phone:781-961-3370
Mailing Address - Fax:781-961-1291
Practice Address - Street 1:MOTION PT GROUP
Practice Address - Street 2:1353 DORCHESTER AVE.
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02122
Practice Address - Country:US
Practice Address - Phone:617-740-2415
Practice Address - Fax:617-740-2413
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11047225100000X
MAPT11047225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY68789Medicare ID - Type Unspecified