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NPI Code Detail

MEDICARE: MS. BEVERLY A HOLDEMAN L.M.T., M.M.P.

MEDICARE: MS. BEVERLY A HOLDEMAN L.M.T., M.M.P.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225700000XMassage TherapistMT 05786AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MT 05786OTHERLICENSED MASSAGE THERAPIST
2448408 00OTHERNATIONAL CERTIFICATION BOARD OF THERAPEUTIC MASSAGE AND BODYWORK

General Provider Information

NPI Number : 1922250083
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. BEVERLY A HOLDEMAN L.M.T., M.M.P.
Provider Business Mailing Address
First Line : 4212 W CREEDANCE BLVD
Second Line :
City : GLENDALE
State : AZ
Zip : 85310-4072
Country : US
Telephone Number : 623-780-7598
Fax Number :
Provider Business Practice Location Address
First Line : 4212 W CREEDANCE BLVD
Second Line :
City : GLENDALE
State : AZ
Zip : 85310-4072
Country : US
Telephone Number : 623-780-7598
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/21/2008
Last Update Date : 10/21/2008

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