Healthcare Provider Details

I. General information

NPI: 1780725515
Provider Name (Legal Business Name): HOLLY K. TOWKANIUK C.M.T., H.H.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 W 11TH ST STE 102
TRACY CA
95376-3960
US

IV. Provider business mailing address

2471 GARRETT CT
TRACY CA
95377-8660
US

V. Phone/Fax

Practice location:
  • Phone: 209-814-7323
  • Fax:
Mailing address:
  • Phone: 209-814-7323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number4524
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number4524
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number4524
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number4524
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: