Healthcare Provider Details

I. General information

NPI: 1396095584
Provider Name (Legal Business Name): HOLLY REBECCA BUHLER L.M.T, M.M.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2012
Last Update Date: 09/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 E SOUTHERN AVE
MESA AZ
85204-5411
US

IV. Provider business mailing address

2500 E SOUTHERN AVE
MESA AZ
85204-5411
US

V. Phone/Fax

Practice location:
  • Phone: 480-298-9319
  • Fax:
Mailing address:
  • Phone: 480-298-9319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT-11220
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: