MEDICARE: MR. TODD W HOLLAND P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	5501005423	MI
2	225100000X	Physical Therapist	7351	AZ

General Provider Information

NPI Number	:	1639177090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TODD W HOLLAND P.T.

Provider Business Mailing Address
First Line	:	17233 N HOLMES BLVD
Second Line	:	SUITE 1650
City	:	PHOENIX
State	:	AZ
Zip	:	85053-2018
Country	:	US
Telephone Number	:	602-547-1836
Fax Number	:	602-547-0809

Provider Business Practice Location Address
First Line	:	17233 N HOLMES BLVD
Second Line	:	SUITE 1650
City	:	PHOENIX
State	:	AZ
Zip	:	85053-2018
Country	:	US
Telephone Number	:	602-547-1836
Fax Number	:	602-547-0809

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	08/05/2009

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Directions to “ MR. TODD W HOLLAND P.T.” Practice Location

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