Provider Demographics
NPI:1073372603
Name:PEARL, HOLLY ANN
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:ANN
Last Name:PEARL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13999 W WAINWRIGHT DR STE 201
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-1967
Mailing Address - Country:US
Mailing Address - Phone:208-939-0775
Mailing Address - Fax:
Practice Address - Street 1:13999 W WAINWRIGHT DR STE 201
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-1967
Practice Address - Country:US
Practice Address - Phone:208-939-0775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist