Provider Demographics
NPI:1669752325
Name:HOLLAND, DIANE LYNN (PT,CWS, CPED)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:LYNN
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:PT,CWS, CPED
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:LYNN
Other - Last Name:MCILHARGY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:32 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-1832
Mailing Address - Country:US
Mailing Address - Phone:845-642-0027
Mailing Address - Fax:
Practice Address - Street 1:32 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-1832
Practice Address - Country:US
Practice Address - Phone:845-642-0027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-25
Last Update Date:2023-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0113961225100000X
NJQAO5442225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist