Holly Mahan, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

5502003415 Issued in MI

Practice address

2300 Haggerty Rd Ste 1110
W Bloomfield, MI 48323-2185

Phone

(248) 669-2000

Fax

(248) 669-2110

NPI assigned

Feb 5, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1549324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549324800000",
    "number": "1457816449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 HAGGERTY RD STE 1110",
            "city": "W BLOOMFIELD",
            "state": "MI",
            "postal_code": "483232185",
            "telephone_number": "248-669-2000",
            "fax_number": "248-669-2110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 HAGGERTY RD STE 1110",
            "city": "W BLOOMFIELD",
            "state": "MI",
            "postal_code": "483232185",
            "telephone_number": "248-669-2000",
            "fax_number": "248-669-2110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAHAN",
        "first_name": "HOLLY",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-02-05",
        "last_updated": "2019-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MI",
            "license": "5502003415",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laura Elizabeth Large, L.M.S.W.
• Lydia Marie Lasichak, M.D.
• Zvi Levran, MD
• Thomas H Li, M.D.
• Mark D Mackey, M.D
• Ayshia Malik
• Jerald B Maltzman, M.D.
• MBK PLLC
• Kathy McGee, LLP
• Medical Consultant PLLC (Endocrinology, Diabetes and Bone Center)

• Physical Therapy Assistant in W Bloomfield, MI
• Providers in W Bloomfield, MI by specialty
• Physical Therapy Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.