Healthcare Provider Details

I. General information

NPI: 1730503152
Provider Name (Legal Business Name): RYAN HOLLEY LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2014
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3654 SILERSIDE RD
WILMINGTON DE
19810
US

IV. Provider business mailing address

17 PERKINS AVE
WILMINGTON DE
19809-1721
US

V. Phone/Fax

Practice location:
  • Phone: 302-437-6823
  • Fax:
Mailing address:
  • Phone: 302-437-6823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM1400X
TaxonomyNurse Massage Therapist (NMT)
License NumberL1-0075765
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT-0002855
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: