Provider Demographics
NPI:1487790499
Name:HOLLAND, MELLISA MARIE
Entity type:Individual
Prefix:
First Name:MELLISA
Middle Name:MARIE
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MELLISA
Other - Middle Name:MARIE
Other - Last Name:COGNATA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:73 NEWTON RD
Mailing Address - Street 2:STE 101
Mailing Address - City:PLAISTOW
Mailing Address - State:NH
Mailing Address - Zip Code:03865-2424
Mailing Address - Country:US
Mailing Address - Phone:978-388-7272
Mailing Address - Fax:978-388-7373
Practice Address - Street 1:297 DANIEL WEBSTER HWY
Practice Address - Street 2:SUITE 2
Practice Address - City:MERRIMACK
Practice Address - State:NH
Practice Address - Zip Code:03054-4451
Practice Address - Country:US
Practice Address - Phone:603-262-3305
Practice Address - Fax:603-262-3306
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
7819287OtherCIGNA GROUP #
AA 11345OtherHARVARD PILGRIM GROUP #
NH08Y011430NH01OtherANTHEM INDIV. #
7819287OtherCIGNA GROUP #
NHRE8985Medicare ID - Type UnspecifiedINDIV MEDICARE #
487882900OtherDEPT OF LABOR FACILITY #