Provider Demographics
NPI:1821544107
Name:HOLLAND, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 BAY RIDGE DRIVE
Mailing Address - Street 2:#D
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10 GEORGE STREET
Practice Address - Street 2:#310
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-2241
Practice Address - Country:US
Practice Address - Phone:978-452-1776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19602225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist