Healthcare Provider Details

I. General information

NPI: 1356371629
Provider Name (Legal Business Name): WALTER RALPH HOLLAND P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 W 71ST ST
NEW YORK NY
10023-3766
US

IV. Provider business mailing address

35 W 92ND ST APT. 7G
NEW YORK NY
10025-7639
US

V. Phone/Fax

Practice location:
  • Phone: 212-721-6200
  • Fax:
Mailing address:
  • Phone: 212-280-0275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0087433
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: