Provider Demographics
NPI:1912957424
Name:HOLL, WILLIAM EDWARD (PT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:EDWARD
Last Name:HOLL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:328 WHEATSHEAF LN
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1553
Mailing Address - Country:US
Mailing Address - Phone:215-499-9807
Mailing Address - Fax:
Practice Address - Street 1:1413 W MOYAMENSING AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-4625
Practice Address - Country:US
Practice Address - Phone:267-639-2555
Practice Address - Fax:267-639-2632
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAPT005529L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001517832 0003Medicaid
PA001517832 0003Medicaid