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General NPI Number Information
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NPI Number | 1295685436
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Entity Type | Individual
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Provider Name | HOLLY THIEDEMAN PT
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Gender | Female
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Dates
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Enumeration Date | 01/28/2026
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Last Update Date | 01/28/2026
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Provider Practice Location Address
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Address Line | 84 E GRANT ST STE 3
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City | WOODSTOWN
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State | NJ
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Zip | 08098-1400
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Country | US
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Telephone | 856-769-4564
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Fax |
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Provider Business Mailing Address
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Address Line | 133 DELAWARE XING
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City | SWEDESBORO
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State | NJ
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Zip | 08085-4207
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Country | US
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Telephone |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40QA02349600
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License Number State | NJ
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