Provider Demographics
NPI:1427339712
Name:POLITIS, HOLLY L
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:L
Last Name:POLITIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:
Other - Last Name:POLITIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ATC
Mailing Address - Street 1:279 BUSINESS ROUTE 4
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CENTER RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05736-9701
Mailing Address - Country:US
Mailing Address - Phone:802-773-8600
Mailing Address - Fax:
Practice Address - Street 1:279 BUSINESS ROUTE 4
Practice Address - Street 2:SUITE 3
Practice Address - City:CENTER RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05736-9701
Practice Address - Country:US
Practice Address - Phone:802-773-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT104.00788772251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports