Provider Demographics
NPI:1912607995
Name:HOCHWALT, HOLLY (PTA)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:HOCHWALT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:
Other - Last Name:WULCZYNSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 540640
Mailing Address - Street 2:
Mailing Address - City:NORTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84054-0640
Mailing Address - Country:US
Mailing Address - Phone:801-987-8600
Mailing Address - Fax:
Practice Address - Street 1:257 COTTONWOOD ST
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:CO
Practice Address - Zip Code:81416-4400
Practice Address - Country:US
Practice Address - Phone:970-874-6111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant