Healthcare Provider Details

I. General information

NPI: 1407073083
Provider Name (Legal Business Name): REBECCA LYNN HOLVERSTOTT LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14700 NE 8TH ST STE 115
BELLEVUE WA
98007-4115
US

IV. Provider business mailing address

10710 SE 256TH ST APT G204
KENT WA
98030-9334
US

V. Phone/Fax

Practice location:
  • Phone: 425-644-8386
  • Fax: 425-644-2560
Mailing address:
  • Phone: 206-355-1804
  • Fax: 425-289-0095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00016540
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: