Healthcare Provider Details

I. General information

NPI: 1639004096
Provider Name (Legal Business Name): LYNN ANN HOLTON LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 JEWEL BASIN CT STE 3B
BIGFORK MT
59911-6294
US

IV. Provider business mailing address

242 STAGE RDG
BIGFORK MT
59911-3664
US

V. Phone/Fax

Practice location:
  • Phone: 406-282-1879
  • Fax:
Mailing address:
  • Phone: 406-282-1879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberLMT-LMT-LIC-28445
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: