MEDICARE: TIMOTHY RYAN HOLLAND

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	2251X0800X	Orthopedic Physical Therapist	40QA02041400	NJ

General Provider Information

NPI Number	:	1972272680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY RYAN HOLLAND

Provider Business Mailing Address
First Line	:	378 GRANDE RIVER BLVD
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08755-1191
Country	:	US
Telephone Number	:	732-770-0144
Fax Number	:

Provider Business Practice Location Address
First Line	:	771 BLOOMFIELD AVE
Second Line	:
City	:	WEST CALDWELL
State	:	NJ
Zip	:	07006-6701
Country	:	US
Telephone Number	:	973-521-5554
Fax Number	:

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

Provider Enumeration Date	:	09/08/2021
Last Update Date	:	09/08/2021

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Directions to “ TIMOTHY RYAN HOLLAND ” Practice Location

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