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General NPI Number Information
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NPI Number | 1164169223
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Entity Type | Individual
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Provider Name | MATTHEW S HOLLOWAY
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Gender | Male
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Dates
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Enumeration Date | 05/19/2022
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Last Update Date | 05/19/2022
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Provider Practice Location Address
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Address Line | 516 GARNET CT
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City | MISSOULA
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State | MT
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Zip | 59801-7065
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Country | US
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Telephone | 406-219-6368
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5657
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City | MISSOULA
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State | MT
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Zip | 59806-5657
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Country | US
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Telephone |
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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 | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State | MT
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