Healthcare Provider Details

I. General information

NPI: 1831732205
Provider Name (Legal Business Name): HOLLY JEAN ROBINSON LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2019
Last Update Date: 10/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12727 W 14TH AVE
AIRWAY HEIGHTS WA
99001-9409
US

IV. Provider business mailing address

12727 W 14TH AVE
AIRWAY HEIGHTS WA
99001-9409
US

V. Phone/Fax

Practice location:
  • Phone: 509-244-4818
  • Fax: 509-244-8945
Mailing address:
  • Phone: 509-244-4818
  • Fax: 509-244-8945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60808417
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: