Healthcare Provider Details

I. General information

NPI: 1912802257
Provider Name (Legal Business Name): HOLLY IBARRA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 S INTERSTATE 35 STE 235
AUSTIN TX
78704-2600
US

IV. Provider business mailing address

2329 EDENBORN AVE
METAIRIE LA
70001-1815
US

V. Phone/Fax

Practice location:
  • Phone: 512-547-1220
  • Fax: 888-830-8403
Mailing address:
  • Phone: 504-571-5355
  • Fax: 504-389-4558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT122397
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: