Provider Demographics
NPI:1356371629
Name:HOLLAND, WALTER RALPH (PT)
Entity type:Individual
Prefix:MR
First Name:WALTER
Middle Name:RALPH
Last Name:HOLLAND
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 W 92ND ST
Mailing Address - Street 2:APT. 7G
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-7639
Mailing Address - Country:US
Mailing Address - Phone:212-280-0275
Mailing Address - Fax:
Practice Address - Street 1:211 W 71ST ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-3766
Practice Address - Country:US
Practice Address - Phone:212-721-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0087433225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY831031OtherEMPIRE UNITED HEALTHCARE
NYQP991OtherEMPIRE BC/BS
NYQN4391Medicare ID - Type Unspecified