Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 40QA00984100 | NJ |
NPI | 1104974625 |
---|---|
Provider Name | Melissa Holland |
First Address | Denville, NJ 07834-3482 |
Second Address | West Caldwell, NJ 07006-7127 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 08/07/2007 |