Provider Demographics
NPI:1891758603
Name:FIRUTA, HOLLY ANN (PT)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:ANN
Last Name:FIRUTA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32828 OCEAN REACH DR
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-4658
Mailing Address - Country:US
Mailing Address - Phone:302-444-8318
Mailing Address - Fax:302-444-8309
Practice Address - Street 1:32828 OCEAN REACH DR
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958
Practice Address - Country:US
Practice Address - Phone:302-444-8318
Practice Address - Fax:302-444-8309
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPTO05205L225100000X
DEJ1-0001328225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1891758603Medicaid
DE1891758603Medicaid
DE140983ZBSXMedicare PIN
5692481OtherAETNA
DE3740960000OtherIBC
P00692861OtherRAILROAD MEDICARE