MEDICARE: MR. BRIAN JAMISON HOLLOWAY LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MA53962	FL

General Provider Information

NPI Number	:	1013242247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRIAN JAMISON HOLLOWAY LMT

Provider Business Mailing Address
First Line	:	57 ORCHARD LN APT N
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32176-5709
Country	:	US
Telephone Number	:	386-299-1280
Fax Number	:

Provider Business Practice Location Address
First Line	:	1893 N CLYDE MORRIS BLVD
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32117-5535
Country	:	US
Telephone Number	:	386-676-2364
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2009
Last Update Date	:	10/06/2009

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