Provider Demographics
NPI:1962423475
Name:JOHNSON, HOLLACE M (PT)
Entity type:Individual
Prefix:
First Name:HOLLACE
Middle Name:M
Last Name:JOHNSON
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:SLEEPY HOLLOW PHYSICAL THERAPY
Mailing Address - Street 2:24 SAW MILL RIVER ROAD, SUITE # 204
Mailing Address - City:HAWTHORNE
Mailing Address - State:NY
Mailing Address - Zip Code:10532
Mailing Address - Country:US
Mailing Address - Phone:914-631-6969
Mailing Address - Fax:
Practice Address - Street 1:SLEEPY HOLLOW PHYSICAL THERAPY
Practice Address - Street 2:24 SAW MILL RIVER ROAD, SUITE # 204
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532
Practice Address - Country:US
Practice Address - Phone:914-631-6969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0032312251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ42741Medicare ID - Type Unspecified