Provider Demographics
NPI:1033484787
Name:HOLLAND, SEAN LEE (LMT)
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:LEE
Last Name:HOLLAND
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4141 16TH ST
Mailing Address - Street 2:APT 1405
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-2785
Mailing Address - Country:US
Mailing Address - Phone:772-563-3730
Mailing Address - Fax:
Practice Address - Street 1:4141 16TH ST
Practice Address - Street 2:APT 1405
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-2785
Practice Address - Country:US
Practice Address - Phone:772-563-3730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-14
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA67552172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist