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General NPI Number Information
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NPI Number | 1811435274
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Entity Type | Individual
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Provider Name | SIMONE HOLDERBACH LMP/NKT
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Gender | Female
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Dates
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Enumeration Date | 02/06/2017
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Last Update Date | 02/06/2017
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Provider Practice Location Address
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Address Line | 11417 124TH AVE NE SUITE 101
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City | KIRKLAND
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State | WA
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Zip | 98033-4677
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Country | US
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Telephone | 425-236-9900
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Fax |
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Provider Business Mailing Address
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Address Line | 13235 NE 202ND CT
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City | WOODINVILLE
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State | WA
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Zip | 98072-8709
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Country | US
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Telephone | 425-949-5011
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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 | MA 60486695
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License Number State | WA
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