Provider Demographics
NPI:1851711816
Name:PENN ERGONOMICS, LLC
Entity Type:Organization
Organization Name:PENN ERGONOMICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OCCUPATIONAL HEALTH
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:F
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPT
Authorized Official - Phone:302-275-8670
Mailing Address - Street 1:190 HAUT BRION AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-4540
Mailing Address - Country:US
Mailing Address - Phone:302-275-8670
Mailing Address - Fax:
Practice Address - Street 1:8015 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19136-2736
Practice Address - Country:US
Practice Address - Phone:302-275-8670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-17
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT016262225100000X
DEJ100014372251E1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251E1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistErgonomicsGroup - Multi-Specialty