Provider Demographics
NPI:1093307688
Name:FLEMING, HOLLY L (MASSAGE LICENSE)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:L
Last Name:FLEMING
Suffix:
Gender:F
Credentials:MASSAGE LICENSE
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:LEAH
Other - Last Name:FLEMING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MASSAGE LICENSE
Mailing Address - Street 1:1520 PRESTON RD APT 122
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8300
Mailing Address - Country:US
Mailing Address - Phone:469-347-2977
Mailing Address - Fax:
Practice Address - Street 1:1520 PRESTON RD APT 122
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8300
Practice Address - Country:US
Practice Address - Phone:469-347-2977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT134461225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty