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General NPI Number Information
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NPI Number | 1013242247
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Entity Type | Individual
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Provider Name | BRIAN JAMISON HOLLOWAY LMT
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Gender | Male
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Dates
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Enumeration Date | 10/06/2009
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Last Update Date | 10/06/2009
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Provider Practice Location Address
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Address Line | 1893 N CLYDE MORRIS BLVD
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-5535
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Country | US
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Telephone | 386-676-2364
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Fax |
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Provider Business Mailing Address
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Address Line | 57 ORCHARD LN APT N
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City | ORMOND BEACH
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State | FL
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Zip | 32176-5709
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Country | US
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Telephone | 386-299-1280
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA53962
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License Number State | FL
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