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General NPI Number Information
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NPI Number | 1487974986
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Entity Type | Individual
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Provider Name | DANIELLE JEAN HOLTEN LMT, OMT
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Gender | Female
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Dates
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Enumeration Date | 06/07/2010
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Last Update Date | 03/04/2011
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Provider Practice Location Address
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Address Line | 1061 109TH AVE NE SUITE D
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City | BLAINE
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State | MN
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Zip | 55434-3846
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Country | US
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Telephone | 763-528-8557
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Fax |
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Provider Business Mailing Address
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Address Line | 1061 109TH AVE NE SUITE D
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City | BLAINE
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State | MN
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Zip | 55434-3846
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Country | US
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Telephone | 763-528-8557
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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 | 2010-00109
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License Number State | MN
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