Individual
CHARLES BOLLACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
11110 MEDICAL CAMPUS RD STE 101, HAGERSTOWN, MD 21742-6711
(301) 665-4970
Mailing address
1635 NEEDY RD, MARTINSBURG, WV 25405-6200
(304) 620-2034
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Enumeration date
05/10/2021
Last updated
05/10/2021
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