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NPI Code Detail

MEDICARE: HOLLY HOGAN LMT

MEDICARE: HOLLY HOGAN 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
1225700000XMassage Therapist4013KY

General Provider Information

NPI Number : 1619411998
Entity Type Code : Individual
Provider Name (Legal Business Name) : HOLLY HOGAN LMT
Provider Business Mailing Address
First Line : 3418 FRANKFORT AVE
Second Line : STE 220
City : LOUISVILLE
State : KY
Zip : 40207-2562
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3418 FRANKFORT AVE
Second Line : STE 220
City : LOUISVILLE
State : KY
Zip : 40207-2562
Country : US
Telephone Number : 502-653-9245
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/06/2016
Last Update Date : 12/06/2016

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