Provider Demographics
NPI:1790233245
Name:HOLLAND, MITCHELL ALEXANDER (ATC)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:ALEXANDER
Last Name:HOLLAND
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2630 W CHESTER PIKE APT F3
Mailing Address - Street 2:
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-2125
Mailing Address - Country:US
Mailing Address - Phone:248-410-2922
Mailing Address - Fax:
Practice Address - Street 1:5600 CITY AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-1308
Practice Address - Country:US
Practice Address - Phone:248-410-2922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-13
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0056162255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer