Provider Demographics
NPI:1104307115
Name:HOLLISCHER, HOWARD (PTA)
Entity type:Individual
Prefix:
First Name:HOWARD
Middle Name:
Last Name:HOLLISCHER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3548 DUPONT AVE S APT 308
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-4025
Mailing Address - Country:US
Mailing Address - Phone:612-275-6067
Mailing Address - Fax:
Practice Address - Street 1:1879 FERONIA AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-3549
Practice Address - Country:US
Practice Address - Phone:651-632-8825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA1725225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant