Provider Demographics
NPI:1093170664
Name:HOLLAND, AMANDA REGINA (LMP)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:REGINA
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:REGINA
Other - Last Name:ISAAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18600 52ND AVE W
Mailing Address - Street 2:APT. B106
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-4590
Mailing Address - Country:US
Mailing Address - Phone:425-931-1273
Mailing Address - Fax:
Practice Address - Street 1:20833 67TH AVE W
Practice Address - Street 2:SUITE 301
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-7365
Practice Address - Country:US
Practice Address - Phone:425-697-0823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-23
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60620250225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist