Provider Demographics
NPI:1013101401
Name:BACASA, HOLLY PUTNAM (PT)
Entity type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:PUTNAM
Last Name:BACASA
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 1:1417 WIGHTMAN ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15217-1240
Mailing Address - Country:US
Mailing Address - Phone:412-421-0310
Mailing Address - Fax:412-421-0312
Practice Address - Street 1:1417 WIGHTMAN ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15217-1240
Practice Address - Country:US
Practice Address - Phone:412-421-0310
Practice Address - Fax:412-421-0312
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT010151L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist