Provider Demographics
NPI:1851303812
Name:HOLLAND, JEROME C (PT)
Entity Type:Individual
Prefix:MR
First Name:JEROME
Middle Name:C
Last Name:HOLLAND
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 RIVERSIDE ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062
Mailing Address - Country:US
Mailing Address - Phone:603-881-9990
Mailing Address - Fax:603-881-4191
Practice Address - Street 1:29 RIVERSIDE ST
Practice Address - Street 2:SUITE C
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062
Practice Address - Country:US
Practice Address - Phone:603-881-9990
Practice Address - Fax:603-881-4191
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1041225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30009156Medicaid
NHRE2438Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID