Provider Demographics
NPI:1427123322
Name:HOLTERHOFF, MARK EDWARD (MA, PT)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:EDWARD
Last Name:HOLTERHOFF
Suffix:
Gender:M
Credentials:MA, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 SURREY DR
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-5222
Mailing Address - Country:US
Mailing Address - Phone:973-835-2827
Mailing Address - Fax:973-835-1856
Practice Address - Street 1:2025 HAMBURG TPKE
Practice Address - Street 2:SUITE E
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-6260
Practice Address - Country:US
Practice Address - Phone:973-835-2827
Practice Address - Fax:973-835-1856
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00135400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP415537Other0XFORD
NJ3K4272OtherHEALTHNET
NJ585518Medicare ID - Type UnspecifiedMEDICARE PROV. ID