Provider Demographics
NPI:1881071389
Name:HOLLAND, MITCHELL (PT, DPT)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:
Last Name:HOLLAND
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6180 144TH LN NW
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:MN
Mailing Address - Zip Code:55303-5673
Mailing Address - Country:US
Mailing Address - Phone:763-236-0006
Mailing Address - Fax:763-236-0079
Practice Address - Street 1:7231 SUNWOOD DR NW STE A
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:MN
Practice Address - Zip Code:55303-5118
Practice Address - Country:US
Practice Address - Phone:763-236-0006
Practice Address - Fax:763-236-0079
Is Sole Proprietor?:No
Enumeration Date:2015-05-04
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9354225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist