Provider Demographics
NPI:1306092911
Name:HETZLER, HOLLY DAWN (MPT, PRPC)
Entity type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:DAWN
Last Name:HETZLER
Suffix:
Gender:F
Credentials:MPT, PRPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 ARONIMINK DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711
Mailing Address - Country:US
Mailing Address - Phone:302-647-9206
Mailing Address - Fax:302-397-2424
Practice Address - Street 1:207 ARONIMINK DRIVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711
Practice Address - Country:US
Practice Address - Phone:302-647-9206
Practice Address - Fax:302-397-2424
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-14
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ10002969225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist