Provider Demographics
NPI:1124080510
Name:BOLLINGER, JAY H (PT)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:H
Last Name:BOLLINGER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:696 WALBORN LN
Mailing Address - Street 2:APT #8
Mailing Address - City:MILLERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17061-1176
Mailing Address - Country:US
Mailing Address - Phone:717-692-4047
Mailing Address - Fax:
Practice Address - Street 1:21 WATERFORD DR
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-8268
Practice Address - Country:US
Practice Address - Phone:717-620-7100
Practice Address - Fax:717-620-7102
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT016569225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101185252 0001Medicaid
PA101185252 0001Medicaid