Provider Demographics
NPI:1457387367
Name:HOLLAND HAGAN, MAUREEN D (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:D
Last Name:HOLLAND HAGAN
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-3110
Mailing Address - Country:US
Mailing Address - Phone:610-873-2114
Mailing Address - Fax:
Practice Address - Street 1:491 JOHN YOUNG WAY
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2567
Practice Address - Country:US
Practice Address - Phone:610-524-7251
Practice Address - Fax:610-280-1506
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT 005499-L2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA23-2084243Medicare ID - Type Unspecified