Provider Demographics
NPI:1790800621
Name:HOLLOS, STEPHANIE LYNNE (PTA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LYNNE
Last Name:HOLLOS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 GRINGS HILL RD
Mailing Address - Street 2:
Mailing Address - City:SINKING SPRING
Mailing Address - State:PA
Mailing Address - Zip Code:19608-2007
Mailing Address - Country:US
Mailing Address - Phone:610-796-7032
Mailing Address - Fax:610-796-2349
Practice Address - Street 1:500 E PHILADELPHIA AVE
Practice Address - Street 2:
Practice Address - City:SHILLINGTON
Practice Address - State:PA
Practice Address - Zip Code:19607
Practice Address - Country:US
Practice Address - Phone:610-796-7032
Practice Address - Fax:610-796-2349
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE001796L225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant