Provider Demographics
NPI:1841530045
Name:HOLLAND, MATTHEW DOUGLAS (PTA)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:DOUGLAS
Last Name:HOLLAND
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1397
Mailing Address - Street 2:1218 NORTH MAIN STREET
Mailing Address - City:CLAYTON
Mailing Address - State:GA
Mailing Address - Zip Code:30525-0035
Mailing Address - Country:US
Mailing Address - Phone:706-782-2585
Mailing Address - Fax:706-782-2012
Practice Address - Street 1:1218 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:GA
Practice Address - Zip Code:30525-0035
Practice Address - Country:US
Practice Address - Phone:706-782-2585
Practice Address - Fax:706-782-2012
Is Sole Proprietor?:No
Enumeration Date:2013-02-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA002793225200000X
NCA4374225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant