Provider Demographics
NPI:1861059735
Name:BOLLENBACHER, MAGGIE (DPT)
Entity type:Individual
Prefix:
First Name:MAGGIE
Middle Name:
Last Name:BOLLENBACHER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:OH
Mailing Address - Zip Code:45828-1703
Mailing Address - Country:US
Mailing Address - Phone:419-763-1464
Mailing Address - Fax:419-763-1482
Practice Address - Street 1:1100 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:FORT RECOVERY
Practice Address - State:OH
Practice Address - Zip Code:45846-8003
Practice Address - Country:US
Practice Address - Phone:419-763-1464
Practice Address - Fax:419-763-1482
Is Sole Proprietor?:No
Enumeration Date:2019-05-25
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT017944225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist