MEDICARE: CHRISTIAN HOLSTEN ATC, AT/L, LMP

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	2255A2300X	Athletic Trainer	A1 60335118	WA
2	225700000X	Massage Therapist	MA 60487459	WA

General Provider Information

NPI Number	:	1699184937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIAN HOLSTEN ATC, AT/L, LMP

Provider Business Mailing Address
First Line	:	915 1ST AVE N
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98109-3608
Country	:	US
Telephone Number	:	509-995-5188
Fax Number	:

Provider Business Practice Location Address
First Line	:	1929 43RD AVE E
Second Line	:	SUITE 100
City	:	SEATTLE
State	:	WA
Zip	:	98112-3297
Country	:	US
Telephone Number	:	206-328-5466
Fax Number	:

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

Provider Enumeration Date	:	08/12/2014
Last Update Date	:	08/12/2014

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