Provider Demographics
NPI:1154736726
Name:POFFENBERGER, HOLLY
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:POFFENBERGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:MAY
Other - Last Name:STEVENTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2119 APPERSON DR
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-7235
Mailing Address - Country:US
Mailing Address - Phone:540-685-0168
Mailing Address - Fax:540-685-0169
Practice Address - Street 1:2119 APPERSON DR
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-7235
Practice Address - Country:US
Practice Address - Phone:540-685-0168
Practice Address - Fax:540-685-0169
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305004112225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist