Provider Demographics
NPI:1427147529
Name:DOLAN, BARBARA W (PT)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:W
Last Name:DOLAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 EDBERT DR
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-1004
Mailing Address - Country:US
Mailing Address - Phone:413-582-0005
Mailing Address - Fax:413-582-7979
Practice Address - Street 1:17 NEW SOUTH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-4073
Practice Address - Country:US
Practice Address - Phone:413-582-0005
Practice Address - Fax:413-582-7979
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1460225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY65857OtherBC/BS
MA0323853Medicaid
MA0323853Medicaid