Lauren Bollacker, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

2306605182 Issued in VA

Practice address

11116 Medical Campus Rd
Hagerstown, MD 21742-6710

Phone

(301) 790-8000

NPI assigned

Dec 27, 2018

Last updated

Apr 7, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

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": "1545868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617753600000",
    "number": "1770055956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1635 NEEDY RD",
            "city": "MARTINSBURG",
            "state": "WV",
            "postal_code": "254056200",
            "telephone_number": "540-877-5003",
            "fax_number": "855-232-8604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11116 MEDICAL CAMPUS RD",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217426710",
            "telephone_number": "301-790-8000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "400 Clocktower Ridge Dr",
            "address_purpose": "LOCATION",
            "city": "Winchester",
            "state": "VA",
            "postal_code": "226033878",
            "country_code": "US",
            "telephone_number": "540-431-2830",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOLLACKER",
        "first_name": "LAUREN",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-12-27",
        "last_updated": "2021-04-07",
        "certification_date": "2021-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "VA",
            "license": "2306605182",
            "primary": true
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MD",
            "license": "A5025",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Barbara Bogley, LCSW
• Danielle Alexandra Bohn
• Shawn Marie Boland, PHARMD, MS, CPPS
• Madhavi Bolarum, MD
• Charles Bollacker, PTA
• Kimberly M Bolland, LCSW-C
• Benjamin J Boniface, DDS
• Nancy Boore, DPT
• Ma Pamela Borden
• Santander Bornacelly, B652758014569

• Physical Therapy Assistant in Hagerstown, MD
• Providers in Hagerstown, MD by specialty
• Physical Therapy Assistant in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2021; 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.