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General NPI Number Information
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NPI Number | 1104307115
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Entity Type | Individual
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Provider Name | HOWARD HOLLISCHER PTA
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Gender | Male
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Dates
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Enumeration Date | 08/27/2018
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Last Update Date | 08/27/2018
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Provider Practice Location Address
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Address Line | 1879 FERONIA AVE
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City | SAINT PAUL
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State | MN
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Zip | 55104-3549
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Country | US
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Telephone | 651-632-8825
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Fax |
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Provider Business Mailing Address
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Address Line | 3548 DUPONT AVE S APT 308
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City | MINNEAPOLIS
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State | MN
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Zip | 55408-4025
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Country | US
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Telephone | 612-275-6067
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | A1725
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License Number State | MN
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